Pharmacological interventions for the prevention of relapse in bipolar disorder: a systematic review of controlled trials

Thirty-four trials were included in the review evaluating pharmacological interventions for relapse prevention in bipolar disorder.

• Lithium, valproate, and lamotrigine show efficacy as maintenance therapies for preventing relapse in bipolar disorder based on placebo-controlled trials.
• Lithium, olanzapine, and aripiprazole significantly prevent manic relapses.
• Valproate, lamotrigine, and imipramine are associated with preventing depressive symptoms.
• Imipramine is infrequently used due to concerns about its adverse effects.
• The significant effects of olanzapine and aripiprazole were noted only in selected responsive bipolar I patients.
• Limited evidence exists to support the efficacy of combination therapy despite its widespread use in practice.

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