Editing Mania (section)

== Treatment ==
Before beginning treatment for mania, careful [[differential diagnosis]] must be performed to rule out secondary causes.

The acute treatment of a manic episode of [[bipolar disorder]] involves the utilization of either a [[mood stabilizer]] (e.g.,[[carbamazepine]], [[valproate]], [[Lithium (medication)|lithium]], or [[lamotrigine]]) or an [[atypical antipsychotic]] (e.g., [[olanzapine]], [[quetiapine]], [[risperidone]], [[aripiprazole]], or [[cariprazine]]).<ref>{{Cite journal |last1=Pacchiarotti |first1=I. |last2=Anmella |first2=G. |last3=Colomer |first3=L. |last4=Vieta |first4=E. |date=September 2020 |title=How to treat mania |url=https://onlinelibrary.wiley.com/doi/10.1111/acps.13209 |journal=Acta Psychiatrica Scandinavica |language=en |volume=142 |issue=3 |pages=173–192 |doi=10.1111/acps.13209 |pmid=33460070 |s2cid=221616169 |issn=0001-690X |access-date=2022-04-20 |archive-date=2022-08-09 |archive-url=https://web.archive.org/web/20220809161811/https://onlinelibrary.wiley.com/doi/10.1111/acps.13209 |url-status=live }}</ref> More recently, substances such as [[iloperidone]] have been approved for the acute treatment of manic episodes related to [[bipolar I disorder]].<ref>{{Cite web |date=2024-04-02 |title=FDA Approves Fanapt for Mixed, Manic Episodes Associated With Bipolar I Disorder |url=https://www.psychiatrictimes.com/view/fda-approves-fanapt-for-mixed-manic-episodes-associated-with-bipolar-i-disorder |access-date=2024-04-27 |website=Psychiatric Times |language=en |archive-date=2024-04-27 |archive-url=https://web.archive.org/web/20240427051528/https://www.psychiatrictimes.com/view/fda-approves-fanapt-for-mixed-manic-episodes-associated-with-bipolar-i-disorder |url-status=live }}</ref> The use of [[antipsychotic]] agents in the treatment of acute mania was reviewed by [[Mauricio Tohen|Tohen]] and [[Eduard Vieta|Vieta]] in 2009.<ref>{{Cite journal|last1=Tohen|first1=Mauricio|last2=Vieta|first2=Eduard|date=2009|title=Antipsychotic agents in the treatment of bipolar mania |journal=Bipolar Disorders|volume=11|issue=s2|pages=45–54|doi=10.1111/j.1399-5618.2009.00710.x|doi-access=free |issn=1399-5618|pmid=19538685}}</ref>

When the manic behaviours have gone, long-term treatment then focuses on [[prophylactic]] treatment to try to stabilize the patient's mood, typically through a combination of [[pharmacotherapy]] and [[psychotherapy]].<ref name=":1" /> The likelihood of having a relapse is very high for those who have experienced two or more episodes of mania or depression. While medication for bipolar disorder is important to manage symptoms of mania and depression, studies show relying on medications alone is not the most effective method of treatment. Medication is most effective when used in combination with other bipolar disorder treatments, including [[psychotherapy]], self-help coping strategies, and healthy lifestyle choices.<ref>{{cite web |url=http://www.helpguide.org/mental/bipolar_disorder_medications.htm/ |title=The Bipolar Medication Guide |author1=Melinda Smith |author2=Lawrence Robinson |author3=Jeanne Segal |author4=Damon Ramsey |publisher=HelpGuide.org |date=1 March 2012 |access-date=23 March 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120310190007/http://helpguide.org/mental/bipolar_disorder_medications.htm |archive-date=10 March 2012 }}</ref><ref>{{Cite journal |last1=Novick |first1=Danielle M. |last2=Swartz |first2=Holly A. |date=2019 |title=Evidence-Based Psychotherapies for Bipolar Disorder |journal=Focus: Journal of Life Long Learning in Psychiatry |volume=17 |issue=3 |pages=238–248 |doi=10.1176/appi.focus.20190004 |issn=1541-4094 |pmc=6999214 |pmid=32047369}}</ref>

[[Lithium (medication)|Lithium]] is the classic [[mood stabilizer]] to prevent further manic and depressive episodes. A systematic review found that long term lithium treatment substantially reduces the risk of bipolar manic relapse, by 42%.<ref name="pmid14754766">{{cite journal |vauthors=Geddes JR, Burgess S, Hawton K, Jamison K, Goodwin GM | title = Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. | journal = The American Journal of Psychiatry | volume = 161 | issue = 2 | pages = 217–22 | date = February 2004 | pmid = 14754766 | doi = 10.1176/appi.ajp.161.2.217 }}</ref> [[Anticonvulsant|Anticonvulsants]] such as [[valproate]], [[oxcarbazepine]], and [[carbamazepine]] are also used for [[prophylaxis]]. More recent drug solutions include [[lamotrigine]] and [[topiramate]], both anticonvulsants as well.

In some cases, long-acting [[benzodiazepine]]s, particularly [[clonazepam]], are used after other options are exhausted. In more urgent circumstances, such as in emergency rooms, [[lorazepam]], combined with [[haloperidol]], is used to promptly alleviate symptoms of agitation, [[aggression]], and [[psychosis]].

[[Antidepressant]] monotherapy is not recommended for the treatment of depression in patients with bipolar disorders I or II, and no benefit has been demonstrated by combining antidepressants with mood stabilizers in these patients. Some [[Atypical antidepressant|atypical antidepressants]], however, such as [[mirtazapine]] and [[trazodone]], have been occasionally used after other options have failed.<ref name=Nierenberg>{{cite journal | author = Nierenberg AA | title = A critical appraisal of treatments for bipolar disorder | journal = Primary Care Companion to the Journal of Clinical Psychiatry | volume = 12 | issue = Suppl 1 | pages = 23–29 | year = 2010 | pmid = 20628503 | pmc = 2902191 | doi = 10.4088/PCC.9064su1c.04 }}</ref>