Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies.
Since the previous publication of Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines in 1997, there has been a substantial increase in evidence-based treatment options for bipolar disorder. The present guidelines review the new evidence and use criteria to rate strength of evidence and incorporate effectiveness, safety, and tolerability data to determine global clinical recommendations for treatment of various phases of bipolar disorder. The guidelines suggest that although pharmacotherapy forms the cornerstone of management, utilization of adjunctive psychosocial treatments and incorporation of chronic disease management model involving a healthcare team are required in providing optimal management for patients with bipolar disorder. Lithium, valproate and several atypical antipsychotics are first-line treatments for acute mania. Bipolar depression and mixed states are frequently associated with suicidal acts; therefore assessment for suicide should always be an integral part of managing any bipolar patient. Lithium, lamotrigine or various combinations of antidepressant and mood-stabilizing agents are first-line treatments for bipolar depression. First-line options in the maintenance treatment of bipolar disorder are lithium, lamotrigine, valproate and olanzapine. Historical and symptom profiles help with treatment selection. With the growing recognition of bipolar II disorders, it is anticipated that a larger body of evidence will become available to guide treatment of this common and disabling condition. These guidelines also discuss issues related to bipolar disorder in women and those with comorbidity and include a section on safety and monitoring.
Yatham
Lakshmi N
LN
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
Kennedy
Sidney H
SH
O'Donovan
Claire
C
Parikh
Sagar
S
MacQueen
Glenda
G
McIntyre
Roger
R
Sharma
Verinder
V
Silverstone
Peter
P
Alda
Martin
M
Baruch
Philippe
P
Beaulieu
Serge
S
Daigneault
Andree
A
Milev
Roumen
R
Young
L Trevor
LT
Ravindran
Arun
A
Schaffer
Ayal
A
Connolly
Mary
M
Gorman
Chris P
CP
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D002170:Canada; D002908:Chronic Disease; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use*; D008403:Mass Screening / Q000379:methods; D019964:Mood Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D000077152:Olanzapine; D010554:Personality Disorders / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014227:Triazines / Q000009:adverse effects / Q000627:therapeutic use*; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use*
D000927:Anticonvulsants; D014150:Antipsychotic Agents; D014227:Triazines; D001569:Benzodiazepines; D016651:Lithium Carbonate; D014635:Valproic Acid; D000077152:Olanzapine; D000077213:Lamotrigine