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Long-term management of patients with bipolar disorder

Bipolar Disorder is a highly recurrent illness inducing considerable disability and morbidity. The first episode appears in the second or third decade of life, highlighting the importance of clinically effective maintenance treatment for this disorder. Many medications are useful for the treatment of mania, but fewer are efficient for prophylaxis. This update reviews the latest clinical trials on maintenance treatment of bipolar disorder and points to the advantages of using lithium, lamotrigine, olanzapine, valproate, and, to a lesser extent, carbamazepine. Although the majority of studies include medications in monotherapy, it is frequently necessary in clinical practice to combine two different treatments, especially in severely affected patients. While treatment should be started as soon as possible, long-term treatment remains the major challenge.