Gitlin M et al. – Despite the number of agents with demonstrated efficacy as maintenance treatments in bipolar disorder, optimal treatment regimens are still a combination of evidence–based therapy in combination with individualized creative treatment algorithms.

• Literature review using PubMed, Medline, and a hand search of relevant literature.

• Over the last decade, a number of effective maintenance treatments for bipolar disorder have been developed with an evidence base for second-generation antipsychotics and some anticonvulsants.
• Increasing numbers of patients, therefore, are appropriately treated with multiple medications as a maintenance regimen.
• For some medications, maintenance treatment has been demonstrated in randomized controlled trials for both monotherapy and in combination with other mood stabilizers.
• Lithium continues as the oldest well-established maintenance treatment in bipolar disorder with somewhat better efficacy in preventing mania than depression.
• Lamotrigine, olanzapine, and quetiapine have bimodal efficacy in preventing both mania and depression, although lamotrigine’s efficacy is more robust in preventing depression and olanzapine’s efficacy is greater in preventing mania.
• Aripiprazole, ziprasidone, and risperidone long-acting injection all prevent mania, but not depression.
• Less controlled investigations have suggested some evidence of maintenance mood stabilization with carbamazepine, oxcarbazepine, and adjunctive psychotherapy.