Short communications: psychotherapy ID-R), chronicity, frequency of melancholic subtype, HAMD-score or CGI-score. Treatment strategies were optimization of current treatment (N = 14, successful in 9 cases), change to other type of antidepressant medication (N = 3, successful in I case). augmentationtreatment (N = 5, successful in lease), combination treatment of 2 antidepressants (N =4, successful in 2 cases), Ecr (N = I, successful). sleep deprivation (N = 3. successful in 2 cases), light therapy (N =I, not successful), cognitive behavior therapy (N =4, successful in 3 cases).

The management of mania is an important and common clinical challenge. A wide array of psychopharmacological alternatives is available, diverse in their mechanism of action. They include lithium, the antipsychotics, anticonvulsants and others. With the exception of lithium, all these agents have been borrowed from other indications. The wide variety of therapeutic options does not help to clarify the primary pathophysiological mechanisms operative in bipolar disorder. While the development of novel therapeutic agents increases the available armamentarium, there is little clarity as to the place of the novel agents in treatment regimens. A further issue in the treatment of mania is the significant divergence of opinion as to choice of first-line antimanic therapy. This paper attempts to review the evidence of efficacy of the various antimanic agents, with a focus on the novel anticonvulsant and neuroleptic drugs, and to discuss the data available on these novel therapeutic options. ( Int J Psych Clin Pract 2000; 4: 171 - 193).

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