Prophylaxis of affective disorder

Prophylaxis in the form of long-term medication should be considered for patients whose lives are significantly disrupted by recurrent illness; say, two or three episodes within 5 years.

For bipolar patients, lithium is an effective prophylactic that prevents or at least ameliorates further episodes in 70-80 per cent of cases. Carbamazepine, an anticonvulsant drug, is an alternative to lithium, and the two drugs may be given in combination if neither has been successful on its own. Other drugs, including other anticonvulsants such as valproate and lamotrigine, may also be used.

For unipolar patients, lithium is sometimes effective, but antidepressant drugs are probably the best prophylaxis.

Psychological and social measures are also important. Interpersonal and cognitive-behavioural psychotherapies have preventive value. Many patients value the information and peer support available through voluntary organizations such as the Manic Depressive Fellowship.

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