Section - Quick Takes

05. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 Guidelines for the Management of Patients with Bipolar Disorder

Published on July 1, 2023 Certification expiration date: July 1, 2026

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

For the treatment of bipolar II depression, lamotrigine and lithium are first- or second-line treatment options in 2 recent treatment guidelines, from the CANMAT-ISBD and the Royal Australian and New Zealand College of psychiatrists.
Key clinical question: If lamotrigine is first line for bipolar II, what about patients right next door on the mood continuum? When to switch strategies from an antidepressant to lamotrigine?
This question has not been studied, in part because the DSM does not acknowledge the existence of patients with subthreshold bipolarity (or mixity).

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Text version

How do you handle depression in patients with bipolar II? Do you choose treatments based on randomized trial data or treatment guidelines, or have you developed your own opinions? Perhaps you’ve realized that randomized trials are short-term studies and bipolar mood disorders are long-term problems. A long-term perspective shifts decision making from a focus on efficacy to a focus on tolerability and risk. Treatments with less than solid efficacy data but very few side effects and long-term risks can rise up from second or third choice treatment options to first choice or close.

Hi! Jim Phelps here for the Psychopharmacology Institute. What do treatment guidelines say about treating depression in patients with a diagnosis of bipolar II? Let’s take a look and see how they have balanced efficacy and tolerability. Two of the most recent bipolar guidelines are the 2018 CANMAT/ISBD and the 2022 Royal College of Australia and New

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Learning Objectives:

Discuss the importance of nonmanic markers in assessing bipolar features among patients.
Consider the implications of a dimensional approach to the diagnosis of depressive disorders with mixed features and its impact on treatment options.
Evaluate the benefit–risk ratio of antidepressants in light of the results of 8 large meta-analyses.
Reassess the incidence of severe withdrawal symptoms when antidepressants are discontinued and clinical features which distinguish withdrawal from relapse.
Compare the first- and second-line treatment options for bipolar depression in 2 recent treatment guidelines.

Original Release Date: July 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: July 1, 2026

Expert: James Phelps, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

James Phelps declares the following interests:

- McGraw-Hill Publishing Company: Royalties
- W.W. Norton & Co. Publishing Company: royalties

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.