Selection of First-line Treatment for Acute Manic Episodes in Bipolar Patients
Location
LSUHSC-NO
Publication Date
April 2026
Start Date
9-4-2026 10:00 AM
End Date
9-4-2026 2:00 PM
Description
Abstract: Bipolar disorder (BD) is a complex behavioral disorder characterized by intermittent episodes of depression and mania lasting days or even weeks. Manic episodes are characterized by impulsivity, psychomotor agitation, affective instability while depressive episodes are characterized by anhedonia, low mood, and fatigue. Acute manic episodes can be highly destabilizing and destructive (Maina et. al 2007). Acute manic episodes negatively affect relationships, career stability, and healthy living practices further down the line. People in acute manic states are at higher risk of self-endangerment and can even lead to self-harm and suicide. Thus, an acute manic episode is considered a psychiatric emergency that requires immediate treatment. However, treatment approaches for acute mania are currently variable. Most guidelines recommend the use of an atypical antipsychotic as a first-line treatment, but medications within this category vary significantly in their treatment profile, side effects, cross interactions, and other factors. Choosing between these medications to best fit a specific patient requires intimate knowledge of both the drug and the patient's history, in addition to considerations for nonadherence and physical resistance. Additionally, the use of a second drug, usually a mood stabilizer, is situationally recommended. Deciding which treatment regimen to pursue first can have a significant impact on patient outcomes. The purpose of this narrative review is to chronicle and compare existing guidelines for the treatment of acute mania and establish an evidence-based consensus for the best first-choice therapy.
Recommended Citation
Ahmed, Mahad and Mercante, Andrew MD, "Selection of First-line Treatment for Acute Manic Episodes in Bipolar Patients" (2026). Dept. of Psychiatry Research Symposium. 30.
https://digitalscholar.lsuhsc.edu/psych_rd/2026/posters/30
Selection of First-line Treatment for Acute Manic Episodes in Bipolar Patients
LSUHSC-NO
Abstract: Bipolar disorder (BD) is a complex behavioral disorder characterized by intermittent episodes of depression and mania lasting days or even weeks. Manic episodes are characterized by impulsivity, psychomotor agitation, affective instability while depressive episodes are characterized by anhedonia, low mood, and fatigue. Acute manic episodes can be highly destabilizing and destructive (Maina et. al 2007). Acute manic episodes negatively affect relationships, career stability, and healthy living practices further down the line. People in acute manic states are at higher risk of self-endangerment and can even lead to self-harm and suicide. Thus, an acute manic episode is considered a psychiatric emergency that requires immediate treatment. However, treatment approaches for acute mania are currently variable. Most guidelines recommend the use of an atypical antipsychotic as a first-line treatment, but medications within this category vary significantly in their treatment profile, side effects, cross interactions, and other factors. Choosing between these medications to best fit a specific patient requires intimate knowledge of both the drug and the patient's history, in addition to considerations for nonadherence and physical resistance. Additionally, the use of a second drug, usually a mood stabilizer, is situationally recommended. Deciding which treatment regimen to pursue first can have a significant impact on patient outcomes. The purpose of this narrative review is to chronicle and compare existing guidelines for the treatment of acute mania and establish an evidence-based consensus for the best first-choice therapy.