Strategies for Preventing the Recurrence of Bipolar Disorder

In interpreting the maintenance literature for bipolar disorder, attention needs to be paid to importantmethodological issues. In this article, we initially examine the methodological topics that need tobe considered, and we then examine the content of the evidence regarding maintenance treatments.Agents used in the long-term treatment of bipolar disorder possess varying degrees of supportive evidence.By consensus, the number of randomized studies and years of clinical experience with lithiummark it as the evidentially strongest long-term agent for bipolar disorder. Recent studies also demonstratelikely long-term benefit with lamotrigine, and possibly olanzapine. Although we possess fewerrandomized data, some such evidence exists and, along with clinical experience, supports the likelylong-term utility of valproate in the treatment of bipolar disorder as well. Some psychotherapies alsomay possess adjunctive maintenance efficacy.