Mental health

Mood stabilizers for people requiring maintenance therapy for bipolar disorder

Question 8: In individuals with bipolar disorders who require maintenance treatment, are mood stabilizers (lithium carbonate, valproate, or carbamazepine) effective and safe? For how long should these medicines be continued?

Management of psychosis and bipolar disorders

  • Population: adults with bipolar disorder
  • Interventions: mood stabilizers
  • Comparison: placebo
  • Outcomes:
    • symptoms severity
    • disability and functioning
    • adverse effects of treatment
    • quality of life
    • mortality
    • treatment adherence
    • users' and families' satisfaction with care.


Lithium or valproate should be used for the maintenance treatment of bipolar disorder. Treatment with lithium should be initiated only in those settings where personnel and facilities for close clinical and laboratory monitoring are available.
Strength of recommendation: STRONG

Maintenance treatment should continue for at least two years after the last episode of bipolar disorder. Decision to continue maintenance treatment after two years should preferably be done by a mental health specialist.
Strength of recommendation: STRONG

In women with bipolar disorders requiring maintenance treatment and planning a pregnancy or pregnant or breastfeeding, lithium and valproate should be avoided. These individuals should be referred to specialist mental health care, when possible.
Strength of recommendation: STRONG

Evidence profile