During the acute phase, aim for the following serum levels: Lithium 0.8-1.1 mmols/L, Valproic Acid 400-700 mmols/L, Carbamazepine: there is no proven therapeutic level for CBZ. Note that Lithium can be given in a single dose, as can slow-release CBZ, but DVP should be given in two divided doses daily.

Serum levels to be repeated at the trough point (approx 12 hours after last dose) for Lithium about 5 days after most recent dose titration; for DVP and CBZ, serum levels can be done about 3-5 days after most recent dose titration. Common practice is to establish about two consecutive serum levels in the therapeutic range during the acute phase. Thereafter, serum levels can be repeated every 3-6 months.

There is no evidence that blood counts and liver functions need to be done frequently. Blood counts and liver functions should be repeated about 4 weeks after commencement of treatment, and could be repeated once every 3-6 months thereafter. Closer monitoring is, however, required in children below the age of 10, seniors, medically ill patients and patients on more than one medication. Clinical symptoms and signs of hematological, hepatic, cardiovascular and neurological dysfunction are particularly valuable in predicting or timing investigations and remedial treatment.

Thyroid and renal functioning, for Lithium users, needs to be assessed annually. More extensive investigations are to be performed only if there is a clinical indication for this.