The role of neuroleptics in manic-depressive illness.

Neuroleptic drugs are a common treatment for acute mania. Although lithium alone may be effective, for those patients with moderate or severe agitation neuroleptics appear to be superior. Low-potency and high-potency neuroleptics are equally effective in mania, as in schizophrenia. Patients with affective disorders, however, may be highly susceptible to the pseudoparkinsonian or extrapyramidal side effects that can occur with neuroleptics. Moderate doses of neuroleptics can be effective in most patients and can reduce the likelihood of serious side effects. Many bipolar patients have manic relapses despite adequate serum lithium levels, and many of those patients are subsequently maintained on a regimen of neuroleptic drugs in addition to lithium. Using the lowest possible dose of the neuroleptic may decrease the high, long-term risk of tardive dyskinesia. More clinical research is needed to determine the most appropriate use of neuroleptic drugs in bipolar disorder.