Fast Five Quiz: Bipolar Disorder With Agitation

W. Clay Jackson, MD, DipTh


June 17, 2022

Bipolar disorder is a lifelong illness that typically requires long-term, continuous treatment because of the risk for patient relapse. When de-escalation fails to reduce agitation, pharmacologic therapy may be necessary. The goal of pharmacologic therapy in the management of agitation aims to rapidly calm the patient without causing excessive sedation. Three classes of drugs most frequently used for agitation include typical antipsychotics, atypical antipsychotic, and benzodiazepines. These medications can be administered orally, intramuscularly, inhaled, or parenterally. If possible, the selection of medication should be determined using a patient-centered approach to incorporate the patients' beliefs and values regarding their health and treatment.

In patients with severe mental illness, such as bipolar disorder, electroconvulsive therapy (ECT) is typically considered when other treatments, including medications and psychotherapy, have not worked. ECT may be an effective option in patients when rapid treatment response is required, such as patients at high risk for suicide.

Anticonvulsants, such as valproate, have proven to be effective in the treatment and prevention of mania but are not used for the management of agitation.

Learn more about bipolar disorders.


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