Jornal de Depressão e Ansiedade
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Pharmacological Treatment of Refractory Bipolar Disorder: What Does the Evidence Say?

Konstantinos N Fountoulakis

Bipolar disorder constitutes a therapeutical challenge. In spite of intense reseach on its treatment during the last decades, the data on the treatment of refractory bipolar patients are sparse. For acutely manic patients who are partial responders to lithium, valproate or carbamazepine, a good strategy would be to add haloperidol, risperidone, olanzapine, quetiapine or aripiprazole. Adding oxcarbazepine to lithium is also a choice. The treatment of refractory bipolar depressives remains terra incognita and also there is no compelling data for the maintenance treatment of refractory patients. Patients stabilized on combination treatment might do worse if shifted from combination. Conclusively there are only limited and sometimes confusing data on the treatment of refractory bipolar patients. Further focused research is necessary on this group of patients.