Mental Health, Brain Health and Substance Use
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Antipsychotics and mood stabilizers in individuals with bipolar mania

2023 updated

Oral antipsychotic medicines – namely aripiprazole, haloperidol, olanzapine, paliperidone or quetiapine – or mood stabilizers – namely carbamazepine, lithium, valproic acid (sodium valproate) – should be offered to adults with bipolar disorder (current episode mania), carefully balancing effectiveness, side-effects and individual preference.
Strength of recommendation: Strong
Certainty of evidence: LOW

Valproic acid (sodium valproate) should not be used in women and girls of childbearing potential with bipolar disorder in remission owing to the high risk of birth defects and neurodevelopmental disorders in children in utero.
Strength of recommendation: STRONG
Certainty of evidence: LOW

2023 validated

In individuals with bipolar mania, treatment with lithium should be initiated only in those settings where personnel and facilities for close clinical and laboratory monitoring are available
Strength of recommendation: STRONG
Certainty of evidence: VERY LOW

[2012]

Recommendation(s)

Haloperidol is recommended in individuals with bipolar mania.
Strength of recommendation: STRONG
Quality of evidence: VERY LOW

Second-generation antipsychotics may be considered as an alternative to haloperidol in individuals with bipolar mania if availability can be assured and cost is not a constraint.
Strength of recommendation: CONDITIONAL
Quality of evidence: LOW

Lithium, valproate, or carbamazepine should be offered to individuals with bipolar mania.
Strength of recommendation: STRONG
Quality of evidence: VERY LOW

In individuals with bipolar mania, treatment with lithium should be initiated only in those settings where personnel and facilities for close clinical and laboratory monitoring are available.
Strength of recommendation: STRONG
Quality of evidence: VERY LOW

In women with bipolar mania planning a pregnancy or pregnant or breastfeeding, lithium and valproate should be avoided. In this group, low dose haloperidol should be considered with caution.
Strength of recommendation: STRONG
Quality of evidence: VERY LOW