CONTINUATION AND PROPHYLACTIC TREATMENT OF BIPOLAR DISORDER

Objectives: To summarize the evidence for efficacy from published lite rature of biological treatments in the continuation and maintenance ph ases of bipolar disorder, as well as the recommendations about differe nt treatment options made by the working group within the Bipolar Sub- Committee of the Canadian Network for Mood and Anxiety Treatments (CAN MAT). Methods: A review of relevant published literature and proceedin gs of international conferences was conducted. The quality of evidence was assessed and classified according to the Periodic Health Examinat ion criteria, Treatment recommendations of the working group were base d on quality of evidence, a consensus of expert views, and the opinion s of psychiatrists and family physicians from across Canada. Results: There is overwhelming evidence for the efficacy of lithium in the prop hylaxis of bipolar disorder. The evidence for carbamazepine is less ro bust. There are no published double-blind studies with adequate number s of subjects treated with divalproex sodium. Conclusions: During and at the end of the continuation phase it is recommended that mood stabi lizers should remain the mainstay of therapy and that other treatments should be gradually discontinued or maintained only if there is valid reason to do so. Efficacious maintenance treatment can reduce morbidi ty and mortality significantly and improve patients' quality of life.