Bipolar disorders: from remission to maintenance

The management of bipolar disorder has traditionally focused upon the treatment of acute mania and although this is a fundamental aspect of patients' care, other aspects of mood stabilisation, e.g. treatment of depression, have been overshadowed. Most of the problems come when decisions are based only on the potential efficacy of treatments, rather than effectiveness. Efficacy responds to the question: Does a treatment work under ideal conditions?, whereas effectiveness responds to the question: Does a treatment work under the conditions of routine care?. The answer to the second question should be more relevant to clinicians. Moreover, in the past decade we have learned that beyond improvement and short-term response, we have to design our therapies to achieve remission and maintain it successfully, which means recovery.