title: [Lithium and anticonvulsants in the treatment of mania and in the prophylaxis of recurrences].
abstract: BACKGROUND
  A mood stabilizer is an agent effective in treating both poles of the illness and at the same time being able to prevent both manic and depressive episodes in bipolar disorder. According to a broader definition, a mood stabilizer should be effective in decreasing the frequency or severity of any type of episode in bipolar disorder, without worsening the frequency or severity of episodes of opposite polarity. According to this, anticonvulsants and atypical antipsychotics can be considered as mood stabilizers.
  
  
  OBJECTIVE
  In this paper we review the use of lithium and other anticonvulsants that have proved effective in randomized controlled trials of the treatment of manic episodes and prevention of recurrences of bipolar disorder.
  
  
  RESULTS
  Lithium and valproate are considered as first-line treatment options for acute mania while evidence regarding carbamazepine is insufficient to consider it as a first-line agent. Patients who fail to respond to first-line treatments may benefit from the adjunct of an atypical antipsychotic such as olanzapine, quetiapine, risperidone or aripiprazole. Lithium retains the strongest evidence of efficacy in the prophylaxis of manic episodes, lamotrigine in the prevention of depressive episodes. Valproate and carbamazepine have no indication for long-term treatment of bipolar disorder.
  
  
  CONCLUSIONS
  Lithium can still be considered a gold standard in the treatment of manic episodes as well as in the prophylaxis of recurrences. Other anticonvulsants should be employed in particular situations, such as valproic acid in the treatment of mania and lamotrigine in the prevention of depressive recurrences.
authors.affiliation: Servizio per i Disturbi Depressivi e d’Ansia, Dipartimento di Neuroscienze, Università di Torino.
authors.forename: Virginio
authors.initials: V
authors.lastname: Salvi
authors.forename: Alberto
authors.initials: A
authors.lastname: Cat Berro
authors.forename: Elisa
authors.initials: E
authors.lastname: Bechon
authors.forename: Filippo
authors.initials: F
authors.lastname: Bogetto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maina
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use*; D012008:Recurrence; D013997:Time Factors
chemical_list: D000927:Anticonvulsants; D018020:Lithium Compounds