r. One of the problems associated with lithium is the fact thelong-term lithium treatment has been associated with decreased thyroidfunctioning in patients with bipolar disorder. Preliminary evidencealso suggest that hypothyroidism may actually lead to rapid-cycling(Bauer et al., 1990). Another problem associated with the use oflithium is experienced by pregnant women. Its use during pregnancy hasbeen associated with birth defects, particularly Ebstein's anomaly. Based on current data, the risk of a child with Ebstein's anomaly beingborn to a mother who took lithium during her first trimester ofpregnancy is approximately 1 in 8,000, or 2.5 times that of the generalpopulation (Jacobson et al., 1992). There are other effective treatments for bipolar disorder that areused in cases where the patients cannot tolerate lithium or have beenunresponsive to it in the past. The American Psychiatric Association'sguidelines suggest the next line of treatment to be Anticonvulsantdrugs such as valproate and carbamazepine. These drugs are useful asantimanic agents, especially in those patients with mixed states. Bothof these medications can be used in combination with lithium or incombination with each other. Valproate is especially helpful forpatients who are lithium noncompliant, experience rapid-cycling, or havecomorbid alcohol or drug abuse. Neuroleptics such as haloperidol or chlorpromazine have also beenused to help stabilize manic patients who are highly agitated orpsychotic. Use of these drugs is often necessary because the responseto them are rapid, but there are risks involved in their use. Becauseof the often severe side effects, Benzodiazepines are often used intheir place. Benzodiazepines can achieve the same results asNeuroleptics for most patients in terms of rapid control of agitationand excitement, without the severe side effects. Antidepressants such as the selective serotonin reuptake inhibitors(SSRI'...
