Bipolar disorder maintenance
Long-term pharmacotherapy to prevent manic, hypomanic, and depressive episodes in bipolar disorder. CANMAT 2018 and the Spanish SEP 2024 consensus place lithium, quetiapine, lamotrigine (preferentially in depressive predominance), and valproic acid as first-line. Choice depends on predominant polarity, tolerability, and comorbidities.
ICD-10 F314 drugs
Also known as: Mood stabilization in bipolar disorder
Drugs used for this condition
- AAripiprazoleFirst line · Atypical antipsychotic – dopamine partial agonistFirst-line for acute mania and maintenance therapy of bipolar I disorder per CANMAT 2018. Dose 15–30 mg once daily. Effective in preventing manic episodes; inferior to lamotrigine for preventing depressive episodes.
- ALamotrigineFirst line · Antiepileptic with dual mechanismFirst-line for maintenance therapy of bipolar disorder with depressive predominance per CANMAT 2018 and the Spanish SEP 2024. Not effective for mania. Starting dose 25 mg once daily for 2 weeks with slow titration to 200 mg daily – fast titration raises severe cutaneous reaction risk. Effect develops over 6–8 weeks.
- AOlanzapineFirst line · Atypical antipsychotic – thienobenzodiazepineFirst-line in acute mania and maintenance of bipolar I disorder per CANMAT 2018. Dose 10–20 mg daily. Combined with fluoxetine (Symbyax), FDA-approved for bipolar depression and treatment-resistant depression.
- ARisperidoneFirst line · Atypical antipsychotic – dopamine and serotonin receptor antagonistFirst-line in acute mania as monotherapy or with lithium/valproate per CANMAT 2018. Dose 2–6 mg once daily. Long-acting injectable is preferred for maintenance of bipolar disorder.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit