title: Alternatives to lithium and divalproex in the maintenance treatment of bipolar disorder.
abstract: OBJECTIVE
  The role of lithium carbonate in the maintenance treatment of bipolar disorder is well established. Unfortunately, many patients fail to respond adequately to this agent or are unable to tolerate its adverse effects. Divalproex has become a commonly used alternative to lithium, but it also is ineffective or poorly tolerated in many patients. This article attempts to review the available data on maintenance therapy in bipolar disorder with a variety of anticonvulsants and antipsychotics (both conventional and novel), with reference to relevant studies in acute mania and bipolar depression as well.
  
  
  METHODS
  Evidence on maintenance therapy and relevant acute-phase data were collected using MEDLINE database searches.
  
  
  RESULTS
  Data on maintenance therapy with agents other than lithium and divalproex are sparse, and often derived from open, uncontrolled studies. Implications and flaws of available data are discussed.
  
  
  CONCLUSIONS
  Other than lithium, there are few robust double-blind data to support the use of a variety of agents in the maintenance phase. However, uncontrolled data suggest that a number of agents merit further study.
authors.affiliation: Department of Psychiatry, University of Arizona, Tuscon 85724, USA.
authors.forename: Mukund
authors.initials: M
authors.lastname: Gnanadesikan
authors.forename: Marlene P
authors.initials: MP
authors.lastname: Freeman
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Gelenberg
mesh_terms: D000085:Acetates / Q000627:therapeutic use; D000588:Amines; D000927:Anticonvulsants / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines; D001714:Bipolar Disorder / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002220:Carbamazepine / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids; D003987:Dibenzothiazepines / Q000627:therapeutic use; D000077265:Donepezil; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D007189:Indans / Q000627:therapeutic use; D000077213:Lamotrigine; D016651:Lithium Carbonate / Q000009:adverse effects*; D000077152:Olanzapine; D010879:Piperazines / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D010890:Pirenzepine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000069348:Quetiapine Fumarate; D018967:Risperidone / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use; D000077236:Topiramate; D016896:Treatment Outcome; D014227:Triazines / Q000627:therapeutic use; D014635:Valproic Acid / Q000009:adverse effects*; D005680:gamma-Aminobutyric Acid
chemical_list: D000085:Acetates; D000588:Amines; D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D002121:Calcium Channel Blockers; D003509:Cyclohexanecarboxylic Acids; D003987:Dibenzothiazepines; D015525:Fatty Acids, Omega-3; D007189:Indans; D010879:Piperazines; D010880:Piperidines; D013844:Thiazoles; D014227:Triazines; D000077236:Topiramate; D001569:Benzodiazepines; D016651:Lithium Carbonate; D000069348:Quetiapine Fumarate; D005632:Fructose; D002220:Carbamazepine; D010890:Pirenzepine; D005680:gamma-Aminobutyric Acid; D014635:Valproic Acid; D000077206:Gabapentin; C092292:ziprasidone; D000077265:Donepezil; D003024:Clozapine; D018967:Risperidone; D000077152:Olanzapine; D000077213:Lamotrigine