ORIGINAL PAPER Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry Konstantinos N. Fountoulakis • Siegfried Kasper • Ole Andreassen • Pierre Blier • Ahmed Okasha • Emanuel Severus • Marcio Versiani • Rajiv Tandon • Hans-Ju ¨rgen Mo ¨ller • Eduard Vieta Published online: 24 May 2012 Ó Springer-Verlag 2012 Abstract The current statement is a systematic review of the available data concerning the efficacy of medication treatment of bipolar disorder (BP). A systematic MED- LINE search was made concerning the treatment of BP (RCTs) with the names of treatment options as keywords. The search was updated on 10 March 2012. The literature suggests that lithium, first and second generation anti- psychotics and valproate and carbamazepine are efficacious in the treatment of acute mania. Quetiapine and the olan- zapine–fluoxetine combination are also efficacious for treating bipolar depression. Antidepressants should only be used in combination with an antimanic agent, because they can induce switching to mania/hypomania/mixed states/ rapid cycling when utilized as monotherapy. Lithium, olanzapine, quetiapine and aripiprazole are efficacious during the maintenance phase. Lamotrigine is efficacious in the prevention of depression, and it remains to be clarified whether it is also efficacious for mania. There is some evidence on the efficacy of psychosocial interventions as an adjunctive treatment to medication. Electroconvulsive therapy is an option for refractory patients. In acute manic patients who are partial responders to lithium/valproate/ K. N. Fountoulakis (&) 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos str, (1st Parodos Ampelonon str), 55535 Pylaia, Thessaloniki, Greece e-mail: kfount@med.auth.gr S. Kasper Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria e-mail: biol-psychiatry@meduniwien.ac.at O. Andreassen Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway e-mail: o.a.andreassen@medisin.uio.no P. Blier Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada e-mail: pierre.blier@theroyal.ca A. Okasha Director of WHO Collaborating Center for Research and Training in Mental Health Okasha Institute of Psychiatry, Ain Shams University, Cairo, Egypt e-mail: aokasha35@gmail.com E. Severus Affective Disorders Inpatient Unit, BPs Outpatient Clinic, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universita ¨t Dresden, Dresden, Germany e-mail: Emanuel.Severus@uniklinikum-dresden.de M. Versiani Department of Psychiatry, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil e-mail: marcio.versiani@terra.com.br R. Tandon University of Florida College of Medicine, Gainesville, FL 32669, USA e-mail: rtandon@umich.edu H.-J. Mo ¨ller Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany e-mail: hans-juergen.moeller@med.uni-muenchen.de E. Vieta BPs Programme, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, ENBREC, Barcelona, Catalonia, Spain e-mail: evieta@clinic.ub.es 123 Eur Arch Psychiatry Clin Neurosci (2012) 262 (Suppl 1):S1–S48 DOI 10.1007/s00406-012-0323-x