ABSTRACT
Bipolar disorder (BD) is unique in the sense that the patients vacillate between two opposing mood states: depression and mania. Essentially, the manic exacerbations epitomize the bipolar diathesis and are straightforward to identify given the pronounced nature of the symptoms. The priority in such cases is the quick and safe control of the disturbance, as manic episodes can be very disrupting and dangerous. In this regard, second and third generation antipsychotics have proven invaluable and the armamentarium has increased with the addition of asenapine, cariprazine and brexpiprazole. Current guidelines recommend the use of these agents as first-line pharmacotherapy in acute manic episodes, either alone or in conjunction with mood stabilizers such as lithium and valproate. Since BD is a chronic life-long ailment, prevention of future episodes is pivotal, and in this regard progress has been made in the form of long-acting injectable preparations of atypical antipsychotics. Nonetheless, despite optimal management many patients experience recurrence, and novel agents are required to fulfill this unmet need. Meanwhile, the biopsychosocial model must be followed as closely as possible to reduce the burden of the disease.
