Systematic review of recent guidelines for pharmacological treatments of bipolar disorders in adults

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Abstract

BACKGROUND

To examine the similarities and differences among practice guidelines for managing bipolar disorders (BDs) in adults.

METHODS

A literature search in PubMed/Medline was performed using multiple search terms and bibliographies for guidelines from July 2013 (since FDA approval of lurasidone) to June 2017.

RESULTS

Six treatment guidelines for BDs in adults were identified. These guidelines showed consensus on first-line treatment of mania (mood-stabilizer and/or an antipsychotic), and most first-line medications for bipolar depression. However, beyond first-line treatments, the guidelines’ recommendations showed major differences. Some guidelines did not specify a type of BD. In addition, there was variability in the stages when important treatments, such as electroconvulsive therapy, should be considered and in the recommended treatment—or lack of recommended treatment—for mixed episodes and features.

CONCLUSIONS

This review found consistency across guidelines on first-line recommendations for treating manic and depressive episodes, but wide differences for second- and third-line treatments and for other phases of BD, therefore limiting the generation of any “meta-consensus.” We recommend creating an international workgroup to reconcile the evidence and develop more unified international recommendations.

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