Drug Interactions of Lithium and Other Antimanic/Mood-Stabilizing Medications

Treatments for bipolar disorder often consist of a combination of 2 or more medications that havemood-stabilizing properties. Lithium is the only agent that has shown efficacy for the treatment ofacute mania and acute depression as well as for the prevention of recurrence of mania and depressionin patients with bipolar disorder. Other agents frequently used as mood stabilizers in monotherapy andin combination with lithium are valproate and carbamazepine. Several other drugs that have mood-stabilizingproperties are used in many combinations to effectively manage the spectrum of symptomsof bipolar disorder throughout the acute and maintenance phases. However, side effects and drug-interactionprecautions accompany all agents used to treat bipolar disorder, and often it can be difficultto determine whether a patient is suffering from side effects of treatment or symptoms of the illnessitself. It is important to use the lowest effective dose of any treatment medication, to monitorlaboratory values closely, and to be familiar with the side effects and interaction precautions of eachmedication that a patient is taking. Successful management of medications for the patient with bipolardisorder is a challenge, but increased effort and vigilance by clinicians mean a reduced risk of hospitalizationand fewer office visits for patients.