Efficacy of antimanic treatments in mixed states

Bipolar Disorders, 04/20/2012

All proven antimanic agents, can be recommended in the treatment of mixed/dysphoric states. The totality of evidence with attention paid to the therapeutic index of each agent would suggest that atypical antipsychotics and divalproex be considered as first–line treatment, with lithium and carbamazepine as second–line. Most individuals will require combination therapy for the treatment of mixed states; variable combinations of atypical antipsychotics and conventional mood stabilizers have the most replicated evidence.

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