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

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.