Bipolar affective disorder: a review of current trends and new therapeutic perspectives

Bipolar affective disorder is a chronic mood disorder marked by alternating episodes of mania, hypomania, and depression, leading to functional decline, increased suicide risk, and shortened life expectancy. Lithium remains the first-choice drug for treating and preventing mania; valproate and carbamazepine are effective but carry higher side-effect risks, while atypical neuroleptics work for both mania and depression. For treatment-resistant cases, especially refractory bipolar depression, neuromodulatory techniques (ECT, rTMS, tDCS, VNS) and the use of ketamine and psychedelics such as psilocybin show promising results. Electroconvulsive therapy is the best studied, rTMS and tDCS show moderate efficacy with good tolerance, ketamine provides rapid antidepressant and anti-suicidal effects despite limited long-term data, and phototherapy benefits seasonal and non-seasonal depression with a good safety profile.

Study at a glance

Abstract

Research objective: The aim of this study was to present the current state of knowledge about bipolar affective disorder (BD) — its classification, clinical picture, pharmacological treatment and alternative methods, with particular emphasis on bipolar depression. Methodology: The study is based on a narrative review of recent scientific literature concerning bipolar affective disorder, conducted using the PubMed database with the following keywords: bipolar disorder; bipolar depression; lithium; atypical neuroleptics; ketamine; psilocybin; neuromodulation; electroconvulsive therapy; rTMS; phototherapy. Main conclusions: Bipolar affective disorder is a chronic and recurrent mood disorder characterized by alternating episodes of mania, hypomania and depression, leading to significant functional decline, increased risk of suicide and shortened life expectancy. Lithium remains the drug of first choice for the treatment and prevention of mania, while valproate and carbamazepine are effective but carry a higher risk of side effects, and atypical neuroleptics are active in both mania and depression. For treatment-resistant cases, especially refractory bipolar depression, neuromodulatory techniques (ECT, rTMS, tDCS, VNS) and the use of ketamine and psychedelics such as psilocybin show promising results. Electroconvulsive therapy is currently the best studied of these methods, rTMS and tDCS show moderate efficacy with good tolerance, ketamine provides rapid antidepressant and anti-suicidal effects despite limited long-term data, and phototherapy demonstrates beneficial effects in seasonal and non-seasonal depression with a good safety profile. Application of the study: The findings may support clinicians in improving diagnostic accuracy and optimizing treatment strategies for patients with bipolar affective disorder, particularly through a more individualized approach to the management of bipolar depression. Originality/Novelty of the study: The review integrates recent findings on emerging therapeutic perspectives in bipolar affective disorder, highlighting advances in neuromodulation, ketamine and psychedelic-assisted treatment, and their potential role in addressing treatment-resistant bipolar depression.