Bipolar Disorder Psychopharmacology: Updated Guidelines

In March 2016, the British Association for Psychopharmacology published new bipolar disorder guidelines.

Summary by Flavio Guzman, MD below.

The complete publication is 59 pages long, so I extracted some key points that you may find useful:

• Lithium remains the most effective treatment preventing relapse and admission to hospital in bipolar I disorder (I)

• Lithium prevents relapse to mania and, less effectively, depression (I). The highest dose that produces minimal adverse reactions and effects should be employed.

• Concentrations below 0.6 mmol/L are potentially too low to be fully effective and adverse reactions and effects become important above 0.8 mmol/L.

• Lithium reduces the risk of suicide (I).

• Valproate as monotherapy has limited trial data, is somewhat less effective than lithium in the prevention of relapse.

• Valproate should not usually be considered for women of child-bearing potential (I).

• Carbamazepine as monotherapy is less effective than lithium, has little if any effect on relapse to depression and is liable to interfere with the metabolism of other drugs (I).

• Lamotrigine is effective against depression in long-term treatment (I) and should be considered where depression is the major burden of the illness (IV).

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