title: Continuation and prophylactic treatment of bipolar disorder.
abstract: OBJECTIVE
  To summarize the evidence for efficacy from published literature of biological treatments in the continuation and maintenance phases of bipolar disorder, as well as the recommendations about different treatment options made by the working group within the Bipolar Sub-Committee of the Canadian Network for Mood and Anxiety Treatments (CANMAT).
  
  
  METHODS
  A review of relevant published literature and proceedings of international conferences was conducted. The quality of evidence was assessed and classified according to the Periodic Health Examination criteria. Treatment recommendations of the working group were based on quality of evidence, a consensus of expert views, and the opinions of psychiatrists and family physicians from across Canada.
  
  
  RESULTS
  There is overwhelming evidence for the efficacy of lithium in the prophylaxis of bipolar disorder. The evidence for carbamazepine is less robust. There are no published double-blind studies with adequate numbers of subjects treated with divalproex sodium.
  
  
  CONCLUSIONS
  During and at the end of the continuation phase it is recommended that mood stabilizers should remain the mainstay of therapy and that other treatments should be gradually discontinued or maintained only if there is valid reason to do so. Efficacious maintenance treatment can reduce morbidity and mortality significantly and improve patients' quality of life.
authors.affiliation: Department of Psychiatry, University of Western Ontario, London.
authors.forename: V
authors.initials: V
authors.lastname: Sharma
authors.forename: L N
authors.initials: LN
authors.lastname: Yatham
authors.forename: D R
authors.initials: DR
authors.lastname: Haslam
authors.forename: P H
authors.initials: PH
authors.lastname: Silverstone
authors.forename: S V
authors.initials: SV
authors.lastname: Parikh
authors.forename: R
authors.initials: R
authors.lastname: Matte
authors.forename: S P
authors.initials: SP
authors.lastname: Kutcher
authors.forename: V
authors.initials: V
authors.lastname: Kusumakar
mesh_terms: D000465:Algorithms; D001714:Bipolar Disorder / Q000188:drug therapy*; D003131:Combined Modality Therapy; D004565:Electroconvulsive Therapy; D006801:Humans; D008134:Long-Term Care; D011619:Psychotropic Drugs / Q000008:administration & dosage* / Q000009:adverse effects; D012008:Recurrence
chemical_list: D011619:Psychotropic Drugs