조증의 약물치료 전략

Abstract

Lithium, carbamazepine or valproate has been a first line choice for acute manic episode. Lithium is most effective for classic mania, while carbamazepine and valproate are effective for manic patients with mixed episode and rapid cycles. For manic patients with psychotic features, antipsychotics and benzodiazepine are indicated in addition to mood stabilizer. ECT is indicated to manic patients who do not respond to medications mentioned above and who do not tolerate to medications. The selection of medication depends on the comparison of possible benefits and the risks from the medications based on the medical and psychiatric status of the patient. About 20% to 30% of acute manics do not respond to currently available medications and substantial portions of acute manics relapse. Therefore, it is the paramount responsibility of our professions to develop an optimal therapeutic strategies for these suffering patients.