Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Lakshmi N. Yatham, Sidney H. Kennedy, Sagar V. Parikh, Ayal Schaffer, David J. Bond, Benicio N. Frey, Verinder Sharma, Benjamin I. Goldstein, Soham Rej, Serge Beaulieu, Martin Alda, Glenda MacQueen, Roumen V. Milev, Arun Ravindran, Claire O'Donovan, Diane McIntosh, Raymond W. Lam, Gustavo Vazquez, Flavio Kapczinski, Roger S. McIntyreJan Kozicky, Shigenobu Kanba, Beny Lafer, Trisha Suppes, Joseph R. Calabrese, Eduard Vieta, Gin Malhi, Robert M. Post, Michael Berk

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

Original languageEnglish
Pages (from-to)97-170
Number of pages74
JournalBipolar Disorders
Volume20
Issue number2
DOIs
Publication statusPublished - Mar 1 2018

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Bipolar Disorder
Anxiety
Guidelines
Therapeutics
Lithium
Valproic Acid
Hope
Maintenance
Safety
Risperidone
Anxiety Disorders
Antidepressive Agents
Psychiatry
Comorbidity
Consensus

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. / Yatham, Lakshmi N.; Kennedy, Sidney H.; Parikh, Sagar V.; Schaffer, Ayal; Bond, David J.; Frey, Benicio N.; Sharma, Verinder; Goldstein, Benjamin I.; Rej, Soham; Beaulieu, Serge; Alda, Martin; MacQueen, Glenda; Milev, Roumen V.; Ravindran, Arun; O'Donovan, Claire; McIntosh, Diane; Lam, Raymond W.; Vazquez, Gustavo; Kapczinski, Flavio; McIntyre, Roger S.; Kozicky, Jan; Kanba, Shigenobu; Lafer, Beny; Suppes, Trisha; Calabrese, Joseph R.; Vieta, Eduard; Malhi, Gin; Post, Robert M.; Berk, Michael.

In: Bipolar Disorders, Vol. 20, No. 2, 01.03.2018, p. 97-170.

Research output: Contribution to journalArticle

Yatham, LN, Kennedy, SH, Parikh, SV, Schaffer, A, Bond, DJ, Frey, BN, Sharma, V, Goldstein, BI, Rej, S, Beaulieu, S, Alda, M, MacQueen, G, Milev, RV, Ravindran, A, O'Donovan, C, McIntosh, D, Lam, RW, Vazquez, G, Kapczinski, F, McIntyre, RS, Kozicky, J, Kanba, S, Lafer, B, Suppes, T, Calabrese, JR, Vieta, E, Malhi, G, Post, RM & Berk, M 2018, 'Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder', Bipolar Disorders, vol. 20, no. 2, pp. 97-170. https://doi.org/10.1111/bdi.12609
Yatham, Lakshmi N. ; Kennedy, Sidney H. ; Parikh, Sagar V. ; Schaffer, Ayal ; Bond, David J. ; Frey, Benicio N. ; Sharma, Verinder ; Goldstein, Benjamin I. ; Rej, Soham ; Beaulieu, Serge ; Alda, Martin ; MacQueen, Glenda ; Milev, Roumen V. ; Ravindran, Arun ; O'Donovan, Claire ; McIntosh, Diane ; Lam, Raymond W. ; Vazquez, Gustavo ; Kapczinski, Flavio ; McIntyre, Roger S. ; Kozicky, Jan ; Kanba, Shigenobu ; Lafer, Beny ; Suppes, Trisha ; Calabrese, Joseph R. ; Vieta, Eduard ; Malhi, Gin ; Post, Robert M. ; Berk, Michael. / Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. In: Bipolar Disorders. 2018 ; Vol. 20, No. 2. pp. 97-170.
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AU - Parikh, Sagar V.

AU - Schaffer, Ayal

AU - Bond, David J.

AU - Frey, Benicio N.

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AU - Goldstein, Benjamin I.

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AU - MacQueen, Glenda

AU - Milev, Roumen V.

AU - Ravindran, Arun

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AU - Lam, Raymond W.

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AU - McIntyre, Roger S.

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AU - Kanba, Shigenobu

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AU - Suppes, Trisha

AU - Calabrese, Joseph R.

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