Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: update 2007

Authors


  • CANMAT has received unrestricted educational grant support from Janssen-Ortho, Eli Lilly & Co., and AstraZeneca. LNY has received grant funding from Servier, AstraZeneca, Janssen, Eli Lilly & Co., GlaxoSmithKline, Novartis and Pfizer; has served as a speaker and a consultant/member of advisory boards for AstraZeneca, Novartis, Janssen, Eli Lilly & Co., GlaxoSmithKline, Bristol-Myers Squibb, Oryx and Pfizer; and does not hold any stocks or have any other conflicts with industry. SHK has received grant funding from AstraZeneca, Eli Lilly & Co., GlaxoSmithKline, Janssen-Ortho, Lundbeck and Merck Frosst; has received consultation fees from Advanced Neuromodulation Systems, Inc., Biovail, Boehringer Ingelheim, Eli Lilly & Co., GlaxoSmithKline, Janssen-Ortho, Lundbeck, Organon, Pfizer, Servier and Wyeth Laboratories; and has served on the speakers bureaus for Biovail, Eli Lilly & Co., GlaxoSmithKline, Janssen-Ortho, Lundbeck, Organon, Servier and Wyeth Laboratories. COD has been a consultant to and served on the speakers bureaus and advisory boards for AstraZeneca, Wyeth Laboratories and Biovail. SVP has received unrestricted educational grants from Wyeth Laboratories, Janssen-Ortho, Eli Lilly & Co., AstraZeneca, GlaxoSmithKline, Novartis and Biovail; and speaker's honoraria from AstraZeneca, Eli Lilly & Co., Biovail and Wyeth Laboratories. GMacQ has received grant funding from Lundbeck, AstraZeneca, Eli Lilly & Co., Sanofi-Aventis, Biovail and Janssen; has acted as a consultant to or served on the advisory boards for Eli Lilly & Co., Janssen, Wyeth Laboratories, GlaxoSmithKline and Organon; and has served on the speakers bureaus for Eli Lilly & Co., Janssen, AstraZeneca, Novartis, Lundbeck, Wyeth Laboratories, Organon, Merck, GlaxoSmithKline and Biovail. RSMcI reports commercial associations with AstraZeneca, Eli Lilly & Co., Janssen-Ortho, Organon, Wyeth, Lundbeck, GlaxoSmithKline, Oryx, Biovail, Pfizer and Prestwick. VS reports commercial associations with Eli Lilly & Co., Janssen Pharmaceutica Products, Novartis Pharmaceuticals Corporation, AstraZeneca Pharmaceuticals LP and Servier. SB has received grant funding from CIHR, FRSQ, NARSAD, RSMQ and the Stanley Foundation; research support from AstraZeneca, Biovail and Eli Lilly & Co., Janssen-Ortho, Lundbeck, Merck-Frosst, Novartis, Pfizer and Servier; acted as a consultant to and served on the advisory boards for AstraZeneca, Eli Lilly & Co., GlaxoSmithKline, Janssen-Ortho and Oryx; and served on the speakers bureaus for AstraZeneca, Biovail, Eli Lilly & Co., GlaxoSmithKline, Janssen-Ortho, Lundbeck, Organon, Oryx and Wyeth-Ayerst.

Lakshmi N Yatham, MBBS, FRCPC, MRCPsych (UK), University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada. Fax: + 1 604 822 7922; e-mail: yatham@interchange.ubc.ca

Abstract

In 2005, the Canadian Network for Mood and Anxiety Treatments (CANMAT) published guidelines for the management of bipolar disorder. This update reviews new evidence since the previous publication and incorporates recommendations based on the most current evidence for treatment of various phases of bipolar disorder. It is designed to be used in conjunction with the 2005 CANMAT Guidelines. The recommendations for the management of acute mania remain mostly unchanged. Lithium, valproate and several atypical antipsychotics continue to be recommended as first-line treatments for acute mania. For the management of bipolar depression, new data support quetiapine monotherapy as a first-line option. Lithium and lamotrigine monotherapy, olanzapine plus selective serotonin reuptake inhibitors (SSRI), and lithium or divalproex plus SSRI/bupropion continue to remain the other first-line options. First-line options in the maintenance treatment of bipolar disorder continue to be lithium, lamotrigine, valproate and olanzapine. There is recent evidence to support the combination of olanzapine and fluoxetine as a second-line maintenance therapy for bipolar depression. New data also support quetiapine monotherapy as a second-line option for the management of acute bipolar II depression. The importance of comorbid psychiatric and medical conditions cannot be understated, and this update provides an expanded look at the prevalence, impact and management of comorbid conditions in patients with bipolar disorder.

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