What substance is primarily used in the acute treatment of manic episodes in bipolar disorder?

The substance primarily used in the acute treatment of manic episodes in bipolar disorder is lithium. Lithium is a mood stabilizer that has been extensively studied and is recognized for its effectiveness in reducing the intensity of manic episodes and preventing future mood swings in individuals with bipolar disorder. It works by modulating neurotransmitter levels and enhancing neuroprotective processes, which can help stabilize mood during manic phases.

While other substances mentioned may have roles in the treatment of mood disorders, they are not primarily used for acute mania. For example, sertraline is an antidepressant usually prescribed for depression and anxiety, while phenelzine is a monoamine oxidase inhibitor that is typically used for depression rather than acute mania. Carbamazepine is an anticonvulsant that can be used for mood stabilization but is not the first-line treatment for acute manic episodes. Therefore, lithium remains the most common and effective choice for treating acute mania in bipolar disorder.