Eleven drugs are approved by the US Food and Drug Administration (FDA) for acute mania. For bipolar maintenance, only lithium, aripiprazole, olanzapine, lamotrigine, and adjunctive quetiapine are FDA approved. The standard medications for acute mania include monotherapy and combined therapy. The standard medications for maintenance include lithium, valproate, carbamazepine and second-generation antipsychotics (SGAs). The other established acute and maintenance treatments include benzodiazepines, electroconvulsive therapy (ECT), clozapine and experimental antimanic treatments. All of the medications reviewed have potentially serious adverse consequences that obligate careful pretreatment and ongoing monitoring, and that call for personalized treatment selection. The traditional mood stabilizers, lithium, valproate, and carbamazepine, are teratogenic, particularly in the first trimester, although the risk of cardiovascular malformation with lithium is thought by some to have been over-estimated. In general first-generation antipsychotics (FGAs), SGAs, and, if necessary ECT, are preferred for mania in pregnancy.