Outcome in the pharmacologic treatment of bipolar disorder

Outcome studies of bipolar disorder, the majority of which were conducted before the use of lithium, divalproex, and carbamazepine, generally found that only 50 to 60% of patients achieved good recovery 6 to 12 months after a manic episode. Over the past decade, a number of new pharmacologic studies have provided further information regarding the acute and long-term outcome of patients with bipolar disorder treated with these medications. In addition, better operational criteria to define outcome have been advanced, allowing for easier extrapolation of the results of clinical trials to clinical practice. We review the outcome of studies of lithium, divalproex, and carbamazepine in the acute treatment of episodes of mania and bipolar depression and in the maintenance treatment of bipolar disorder and the implications of these studies to clinical practice.