Maintenance treatments of recurrent affective disorders

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Abstract
Most major affective disorders are recurrent conditions. A minimum period of 4-6 months of continuation therapy is now recommended for all unipolar depression patients, which should continue until the patient has achieved a stable, symptom-free recovery. An extended course of maintenance pharmacotherapy is recommended for unipolar patients at risk for subsequent recurrent episodes. Recent studies document particularly high risks of relapse, recurrence, and cycling in bipolar disorder. It is unclear, however, if the prognosis of bipolar disorder is worsening due to secular factors or if the apparent decline in the success of lithium prophylaxis is a result of various methodologic factors. Although available data are promising, neither carbamazepine nor valproate are definitively proven as first-line prophylactic treatments. Because affective disorders are at increasingly greater risk of becoming more autonomous, severe, and potentially refractory with each new episode, prevention of recurrent illness is the best available strategy to ensure an optimal long-term outcome.

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