Selecting Effective Long-Term Treatment for Bipolar Patients: Monotherapy and Combinations

This article explores the roles of monotherapy and drug combinations in finding effective long-termtreatment for individual patients with bipolar disorder. While current practice relies heavily oncombinations, many bipolar patients can be successfully stabilized if the initial monotherapy is carefullyselected according to the patient's clinical characteristics. The data show that (1) unequivocalresponders to long-term monotherapies such as lithium, lamotrigine, or atypical neuroleptics eachhave a very different clinical profile, including clinical presentation and course, comorbidity, and, inparticular, family history and (2) bipolar patients who respond very well to a long-term monotherapyhave often completely failed on other monotherapies. Combinations appear indicated particularly inbipolar patients who are treatment-resistant to monotherapy, do not tolerate it well, or have not yetexhibited the clinical characteristics needed to choose an effective monotherapy.