Maintenance therapy for bipolar disorder: current and future management options

Bipolar disorder is an episodic condition usually requiring long-term, often life-long, treatment to control acute symptoms and stabilize mood. Clinicians face several challenges when deciding on the most appropriate long-term management strategy for patients with bipolar disorder, and consideration must be given to the heterogeneity of symptoms, tolerability and patient acceptability as well as individual history of response. Numerous treatments are available for the management of bipolar disorder, including lithium, divalproex, conventional antipsychotics, the anticonvulsant lamotrigine, and several newer atypical agents, including olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole. Antidepressants may also have a role in managing acute depressive episodes but are not recommended as monotherapy in either acute or long-term maintenance treatment. Studies suggest that pharmacologic treatment given in conjunction with cognitive therapy or group psychoeducation is superior to usual care. This article reviews current treatment options and management strategies for the long-term maintenance of health in patients with bipolar disorder. Particular emphasis is given to the atypical agents and psychosocial strategies aimed at optimizing treatment adherence and long-term outcomes.