Novel alternatives and supplements to lithium and anticonvulsants for bipolar affective disorder

Background: Most clinicians are familiar with the traditional anticonvulsants as alternatives to lithium in the treatment of bipolar mood disorders. Method: This review of the English, French, German, and Italian language literature on novel treatments, including electroconvulsive therapy, calcium channel blocking agents, antipsychotic drugs, benzodiazepines, thyroid hormone, psychosurgery, and two new antiepileptic drugs, that have not been studied as extensively as lithium, carbamazepine, and valproate but that may have promise as alternatives or supplements to traditional thymoleptics when the standard treatments are not effective or are poorly tolerated. We searched MEDLINE and PSYCHINFO data bases using the keywords bipolar, mood, and/or treatment. We then searched bibliographies of articles retrieved by the first strategy. Results: The theoretical rationale for each treatment is discussed, followed by a critical discussion of the evidence supporting its efficacy. Conclusion: The potential risks and benefits of each treatment in actual clinical practice are placed in perspective.