2013 Update: CANMAT & ISBD Update on Bipolar Disorder Management

Canadian Network for Mood and Anxiety Treatments (CANMAT) and
International Society for Bipolar Disorders (ISBD)
Collaborative Updated Guidelines for Bipolar Disorder Management:
Update 2013.

The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first-line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release, and divalproex ER, as well as adjunctive asenapine, have been added as first-line options.

For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second-line options.

Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not-recommended options for the treatment of bipolar depression.

Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder.

Asenapine alone or as adjunctive therapy have been added as third-line options.