Bipolar affective disorder, also know as manic-depressive illness, is a severe, mostly recurrent mood disorder associated with great morbidity. The mortality rate of the disease is two to three times higher than that of the general population. Unfortunately, about 10-20% of individuals with BD take their own life and nearly one third of patients admit to at least one suicide attempt (Martin, 1981). The clinical manifestations of the disease are exceptionally diverse. The alternating cycles range from mild hypomania to mild depression, to severe forms of mania or depression that can be accompanied by profound psychosis. Bipolar disorder is equally prevalent across sexes, with the exception of rapid cycling, a severe and difficult to treat variant of the condition, which arises mostly in women. Because of the high risk of recurrence and suicide, long-term pharmacological treatment is essential (Coon, 1992).
Fortunately, effective pharmacological treatments are available today that can greatly prevent or alleviate the suffering caused by BD, thus allowing almost all people with BD, substantial stabilization of their mood swings (Coon, 1992). Lithium has been the primary treatment for Bipolar disorder since its introduction in the 1960's. Its main function is to stabilize the cycling characteristic of BD. However, as many as 40% of manic depressive individuals are either unresponsive to lithium or can not tolerate the extreme side effects. More recently, the mood stabilizing anticonvulsant medication sodium valproate has been indicated to be not only equally effective as lithium for the treatment of mania, but also beneficial due to its better tolerance. Also, it is suggested that sodium valproate is especially useful for BD patients who experience rapid cycling, and for those BD individuals who have additional problems associated with alcohol or drug abuse (Hirschfeld, 1995; Hopskins & Gelenberg, 1994).