By David S Baldwin; Jon Birtwistle

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Lithium and valproate are more often used as prophylactic treatments, in an attempt to reduce the risk of future manic or depressive episodes. Lithium Randomized controlled trials of lithium treatment have shown that it is effective in 60–90% of acutely ill patients with manic episodes, and in up to 80% of patients when used in the long-term prophylaxis of bipolar affective disorder74. Lithium is also effective in the prophylaxis of recurrent unipolar depressive disorder, though not as effective as treatment with antidepressant drugs.

Alprazolam, clonazepam and lorazepam) are effective in many patients, but should be reserved for severely ill patients and only used for short-term treatment. g. phenelzine) have been found to be effective in the treatment of panic disorders, but tend to be used less frequently, owing to the need for dietary restrictions and side-effects. g. moclobemide), although not licensed for the treatment of panic, demonstrate potential efficacy and have the benefits of minimum dietary restriction. g. exposure to phobic situation and training in coping with panic attacks) and cognitive therapy are also beneficial in many patients.

0 mmol/l. Monitoring patients during lithium treatment is best done within a mood disorders clinic so that affective symptoms can be monitored conscientiously and sleep disturbance can be treated. The attempt should be made to give all the daily dose of lithium at night, and the patient should be asked about adherence at each visit. The use of additional psychotropic drugs is recom- ©2002 CRC Press LLC Anticonvulsants Sodium valproate was first used in the treatment of primary generalized epilepsy, generalized absences and myoclonic seizures.

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