Drugs are used in mania to control acute attacks and to prevent their recurrence.

Benzodiazepines: Use of benzodiazepines may be helpful in the initial stages of treatment until lithium achieves its full effect; they should not be used for long periods because of the risk of dependence.

Antipsychotic drugs:

In an acute attack of mania, treatment with an antipsychotic drug is usually required because it may take a few days for lithium to exert its antimanic effect.


Carbamazepine may be used for the prophylaxis of bipolar disorder (manic-depressive disorder) in patients unresponsive to lithium; it seems to be particularly effective in patients with rapid-cycling manic-depressive illness (4 or more affective episodes per year).

Valproic acid:

Valproic acid is licensed for the treatment of manic episodes associated with bipolar disorder. It may be useful in patients unresponsive to lithium.


Indications: Bipolar Disorder, Bipolar Disorder in Remission, Manic Bipolar Disorder.

Contraindications: Lactating Mother, Lithium Toxicity, Pregnancy, Chronic Heart Failure, Conduction Disorder of the Heart, Diabetes Insipidus, Hyponatremia, Renal Disease, Severe Dehydration, Severe Infection.

Dose and Administration: For lithium carbonate adult and child over 12 years, treatment, initially 1–1.5 g daily; prophylaxis, initially 300–400 mg daily. For lithium sulphate, Treatment and prophylaxis, initially 1.04–3.12 g daily in 2 divided doses (elderly or patients less than 50 kg, 520 mg twice daily).​