aStudy Group on Affective Disorders (GRUDA) –Institute of Psychiatry of the Clinical

In t roduct ion In the last years the treatment of bipolar disorder (BD) has considerably changed with the regular use of valproate, carbamazepine (CBZ), lamotrigine (LTG) and other anticonvulsants associated with or replacing lithium. It may be highlighted that the interest of the pharmaceutical industry in the BD field has an important role to support its widespread use. This interest has also changed the traditional therapeutic concepts leading to new recommendations (algorithms) and options of pharmacological treatment. Lithium, valproate, CBZ and LTG are well-established treatments, among which lithium shows the most robust evidence of prophylactic efficacy1 and sodium valproate has some evidence of efficacy on rapid cycling.1-3 There has been growing evidence about the efficacy of other anticonvulsants, atypical antipsychotics and the combination of treatments.4 Typical antipsychotics are still used in acute mania, but studies about prophylaxis are still lacking. Bipolar patients may be particularly prone to tardiv