[Treatment and prevention of mania: lithium and alternatives]

Untreated bipolar manic-depressive illness has a very high recurrence rate and, in spite of the development of modern psychopharmacological treatments, the prognosis is still rather poor. Lithium is still the drug of choice for treatment of manic episodes and for prevention of bipolar manic-depressive illness. However, in 30 to 50% of bipolar manic-depressive patients alternative or supplementary treatment with anti-epileptic drugs, neuroleptics or electroconvulsive therapy may prove necessary. It is important to provide manic-depressive patients with an outpatient service which can manage not only the psychopharmacological treatments but also health education, psychotherapy, laboratory monitoring and psychosocial support necessary to secure the patients an effective and careful treatment.