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 2009.
The Canadian Network for Mood and Anxiety Treatments (CANMAT) published guidelines for the management of bipolar disorder in 2005, with a 2007 update. This second update, in conjunction with the International Society for Bipolar Disorders (ISBD), reviews new evidence and is designed to be used in conjunction with the previous publications. The recommendations for the management of acute mania remain mostly unchanged. Lithium, valproate, and several atypical antipsychotics continue to be first-line treatments for acute mania. Tamoxifen is now suggested as a third-line augmentation option. The combination of olanzapine and carbamazepine is not recommended. For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. New data support the use of adjunctive modafinil as a second-line option, but also indicate that aripiprazole should not be used as monotherapy for bipolar depression. Lithium, lamotrigine, valproate, and olanzapine continue to be first-line options for maintenance treatment of bipolar disorder. New data support the use of quetiapine monotherapy and adjunctive therapy for the prevention of manic and depressive events, aripiprazole monotherapy for the prevention of manic events, and risperidone long-acting injection monotherapy and adjunctive therapy, and adjunctive ziprasidone for the prevention of mood events. Bipolar II disorder is frequently overlooked in treatment guidelines, but has an important clinical impact on patients' lives. This update provides an expanded look at bipolar II disorder.
Department of Psychiatry, University of British Columbia,2255 Wesbrook Mall, Vancouver, BC V6T 2A1, , Canada. l.yatham@ubc.ca
Lakshmi N
LN
Yatham
Sidney H
SH
Kennedy
Ayal
A
Schaffer
Sagar V
SV
Parikh
Serge
S
Beaulieu
Claire
C
O'Donovan
Glenda
G
MacQueen
Roger S
RS
McIntyre
Verinder
V
Sharma
Arun
A
Ravindran
L Trevor
LT
Young
Allan H
AH
Young
Martin
M
Alda
Roumen
R
Milev
Eduard
E
Vieta
Joseph R
JR
Calabrese
Michael
M
Berk
Kyooseob
K
Ha
Flávio
F
Kapczinski
D000208:Acute Disease; D014150:Antipsychotic Agents / Q000145:classification / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000628:therapy*; D002170:Canada; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004565:Electroconvulsive Therapy / Q000379:methods*; D006801:Humans; D007391:International Cooperation
D014150:Antipsychotic Agents