Methods. Material used for these
guidelines are based on a systematic literature search using various data bases. Their scientifi c rigor was categorised
into six levels of evidence (A – F) and different grades of recommendation to ensure practicability were assigned. Results.
Maintenance trial designs are complex and changed fundamentally over time; thus, it is not possible to give an overall
recommendation for long-term treatment. Different scenarios have to be examined separately: Prevention of mania,
depression, or an episode of any polarity, both in acute responders and in patients treated de novo . Treatment might
differ in Bipolar II patients or Rapid cyclers, as well as in special subpopulations. We identifi ed several medications
preventive against new manic episodes, whereas the current state of research into the prevention of new depressive
episodes is less satisfactory. Lithium continues to be the substance with the broadest base of evidence across treatment
scenarios. Conclusions. Although major advances have been made since the fi rst edition of this guideline in 2004, there
are still areas of uncertainty, especially the prevention of depressive episodes and optimal long-term treatment of Bipolar
II patients.