2023 updated

Mood stabilizers – namely carbamazepine, lithium, valproic acid (sodium valproate) – or oral antipsychotic medicines – namely aripiprazole, olanzapine, quetiapine – should be considered for maintenance treatment for adults with bipolar disorder in remission, carefully balancing effectiveness, side-effects and individual preference.
Strength of recommendation: CONDITIONAL
Certainty of evidence: LOW

Valproic acid (sodium valproate) should not be used in women and girls of childbearing potential with bipolar disorder in remission owing to the high risk of birth defects and neurodevelopmental disorders in children in utero.
Strength of recommendation: STRONG
Certainty of evidence: LOW

Recommendation(s)

Lithium or valproate or certain second-generation antipsychotics (aripiprazole, olanzapine, paliperidone extended release, quetiapine, and risperidone long acting injection release) can be offered for the maintenance treatment of bipolar disorder. If treatment with one of these agents is not feasible, first-generation antipsychotics or carbamazepine may be used. Maintenance treatment should be offered in primary health care settings under supervision of a specialist.
Strength of recommendation: CONDITIONAL
Quality of evidence: LOW