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

Stephen Hammett, Nagy Adel Youssef

Research output: Contribution to journalReview article

2 Citations (Scopus)

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 (moodstabilizer 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.

Original languageEnglish (US)
Pages (from-to)266-282
Number of pages17
JournalAnnals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists
Volume29
Issue number4
StatePublished - Nov 1 2017

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Bipolar Disorder
Pharmacology
Guidelines
Consensus
Electroconvulsive Therapy
Bibliography
Practice Guidelines
PubMed
Antipsychotic Agents

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Systematic review of recent guidelines for pharmacological treatments of bipolar disorders in adults",
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 (moodstabilizer 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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AU - Youssef, Nagy Adel

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N2 - 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 (moodstabilizer 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.

AB - 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 (moodstabilizer 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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