Bipolar Disorder Treatment Guidelines: A 2017 Update

Last updated: July 18, 2017 at 14:51 pm

By Flavio Guzman, MD

This page offers direct links to the most recent guidelines for the treatment of bipolar disorder. You may notice that we have not included the guidelines published by the American Psychiatric Asssociation, this is because the document has not been updated since 2005.

– 2016 – British Association for Psychopharmacology

Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology

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Selected Key Points

The complete publication is 59 pages long, so we extracted some key points that you may find useful:

  • Lithium remains the most effective treatment preventing relapse and admission to hospital in bipolar I disorder (I).
  • Lithium prevents relapse to mania and, less effectively, depression (I). The highest dose that produces minimal adverse reactions and effects should be employed.
  • Concentrations below 0.6 mmol/L are potentially too low to be fully effective and adverse reactions and effects become important above 0.8 mmol/L.
  • Lithium reduces the risk of suicide (I).
  • Valproate as monotherapy has limited trial data, is somewhat less effective than lithium in the prevention of relapse.
  • Valproate should not usually be considered for women of child-bearing potential (I).
  • Carbamazepine as monotherapy is less effective than lithium, has little if any effect on relapse to depression and is liable to interfere with the metabolism of other drugs (I).
  • Lamotrigine is effective against depression in long-term treatment (I) and should be considered where depression is the major burden of the illness (IV).
Reference: Traditional evidence categories.
  • Evidence category I:

    • Meta-analysis of RCTs, at least one large, good-quality, RCT or replicated, smaller RCTs
    • Large representative population samples
  • Evidence category II:

    • Small, non-replicated RCTs, at least one controlled study without randomization or evidence from at least one other type of quasi-experimental study
  • Evidence category III:

    • Non-experimental descriptive studies, such as uncontrolled, comparative, correlation and case-control studies
    • Non-representative surveys, case reports
  • Evidence category IV:
    • Expert committee reports or opinions and/or clinical experience of BAP expert group

– 2014 – National Institute for Health and Care Excellence (NICE)

Bipolar disorder: the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care (CG185)

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Selected Key Points

The following key points were summarized by Fountoulakis et al.

  • The NICE warns against the use of gabapentin and topiramate.
  • Acute bipolar depression:
    • NICE recommends olanzapine, OFC, quetiapine, lamotrigine, lithium, and valproate.
    • If the patient is already under treatment with lithium or valproate:
      • increase the dosage to the highest permitted, and reassess before changing medications.
    • Next step: combination of lithium or valproate plus quetiapine or OFC.
    • Third step: lithium plus lamotrigine or olanzapine and valproate plus lamotrigine.
  • Maintenance phase:
    • First line treatment
      • Continue the treatment the patient received during the acute phase and led to the resolution of the symptoms
    • Irrespective of predominant polarity, continue treatment for at least 3 to 6 months.
    • In case the patient does not wish to follow this, it is recommended to change treatment to lithium, olanzapine, quetiapine, valproate, or lithium plus valproate.
  • A paper questioned some of the recommendations stating that “in the case of psychological treatment of bipolar disorder, the recommendations seem to go beyond the evidence”

– 2013 – Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD)

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

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– 2012 – World Federation of Societies of Biological Psychiatry (WFSBP)

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2012 on the long-term treatment of bipolar disorder

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The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2010 on the treatment of acute bipolar depression

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The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania

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