Strategies for preventing the recurrence of bipolar disorder.
In interpreting the maintenance literature for bipolar disorder, attention needs to be paid to important methodological issues. In this article, we initially examine the methodological topics that need to be 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 lithium mark it as the evidentially strongest long-term agent for bipolar disorder. Recent studies also demonstrate likely long-term benefit with lamotrigine, and possibly olanzapine. Although we possess fewer randomized data, some such evidence exists and, along with clinical experience, supports the likely long-term utility of valproate in the treatment of bipolar disorder as well. Some psychotherapies also may possess adjunctive maintenance efficacy.
Ghaemi
S Nassir
SN
Bipolar Disorder Research Program, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Mass 02139, USA. ghaemi@hms.harvard.edu
Pardo
Tamara B
TB
Hsu
Douglas J
DJ
D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000517:prevention & control*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D006801:Humans; D000077213:Lamotrigine; D008094:Lithium / Q000627:therapeutic use; D000077152:Olanzapine; D010353:Patient Education as Topic; D011613:Psychotherapy; D055502:Secondary Prevention; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D014227:Triazines / Q000627:therapeutic use; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D000928:Antidepressive Agents; D001569:Benzodiazepines; D000077213:Lamotrigine; D008094:Lithium; D000077152:Olanzapine; D017367:Selective Serotonin Reuptake Inhibitors; D014227:Triazines; D014635:Valproic Acid