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Bipolar disorder is a cyclic disorder with periods of mood elevation (manic episodes) and periods of depression (depressive episodes). During manic episodes, patients may feel very excited, elated, agitated, enthusiastic or hyperactive or have poor judgment including being aggressive or disruptive. During depressive episodes, patients may feel depressed, feel guilty, lack energy, lose their appetite or cannot sleep. To prevent recurrence of future episodes, lifelong treatment is generally recommended.

Mood stabilizers
Lithium and Valproate are effective mood stabilizers against bipolar disorder. However, Lithium has a narrow therapeutic window and the dose must be titrated and adjusted based on regular blood test. Early signs of Lithium toxicity include vomiting, diarrhea and dizziness. Valproate is contraindicated in pregnancy due to teratogenic effects. Women of childbearing potential must use effective contraceptive methods prior to Valproate treatment.

Antipsychotics
Atypical antipsychotics are generally well-tolerated. They may be used as a monotherapy or adjunct to lithium or valproate. Quetiapine and Aripiprazole are the first-line medication for bipolar disorder. Quetiapine is effective in both manic episodes and depressive episodes while Aripiprazole is effective in manic episodes only. Olanzapine is reserved as the second-line medication due to more significant side effects, such as weight gain.

Antidepressants
Medications indicated for depression (e.g. SSRI) may be used as an adjunct to mood stabilizers or antipsychotics during depressive episodes. They should only be used in a short term and must be discontinued during manic episodes.