Prophylaxis of bipolar disorder: how and who should we treat in the long term?

Bipolar disorder is a devastating and chronic mood disorder, which can requ ire life-long treatment. The vast majority of patients will suffer relapse of symptoms in the absence of effective therapy. Of those patients receivin g treatment, compliance to medication regimens is poor. Non-compliance, whe n associated with lithium treatment in particular, increases the risk of re currence of illness. Problems associated with withdrawal serve as powerful stimuli to develop alternatives to lithium monotherapy. Conventional placeb o-controlled studies of treatments are difficult in patients with bipolar d isorder. Large-scale, pragmatic and clinically relevant trials should be em ployed to assess existing and novel treatments for bipolar disorder. These can only develop out of genuine clinician and patient uncertainty and the c reation of a trial culture in everyday practice. (C) 1999 Elsevier Science B.V. All rights reserved.