Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009

Authors

  • Lakshmi N Yatham,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • a Sidney H Kennedy,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • b Ayal Schaffer,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • b Sagar V Parikh,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • b Serge Beaulieu,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • c Claire O'Donovan,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • d Glenda MacQueen,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • e Roger S McIntyre,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • b Verinder Sharma,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • f Arun Ravindran,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • b L Trevor Young,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • a Allan H Young,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • a Martin Alda,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • d Roumen Milev,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • g Eduard Vieta,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • h Joseph R Calabrese,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • i Michael Berk,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • j Kyooseob Ha,

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • and k Flávio Kapczinski l

    1. Affiliations
      aDepartment of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, cDepartment of Psychiatry, McGill University, Montreal, QC, dDepartment of Psychiatry, Dalhousie University, Halifax, NS, eDepartment of Psychiatry, University of Calgary, Calgary, Alberta, fDepartment of Psychiatry, University of Western Ontario, London, ON, gDepartment of Psychiatry, Queen’s University, Kingston, ON, Canada, hBipolar Disorder Program, University of Barcelona Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, iMood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA, jDepartment of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia, kDepartment of Psychiatry, Seoul National University, Seoul, Korea, lBipolar Disorders Program, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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  • The authors dedicate the CANMAT/ISBD guidelines to Dr. Vivek Kusumakar, who passed away suddenly on January 14, 2009. He was an editor for the first CANMAT Guidelines for bipolar disorder, published in 1997. Dr. Kusumakar’s intellectual curiosity to understand the causes of mental illnesses, scientific ability to lead discovery and development of new treatments, develop and disseminate innovative educational programs to improve outcomes for people with bipolar disorder, and his drive for excellence, along with an ability to inject his vision and enthusiasm to his colleagues will be sorely missed.

  • Affiliations and disclosure information for all authors are listed before the references.

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

Abstract

The Canadian Network for Mood and Anxiety Treatments (CANMAT) published guidelines for the management of bipolar disorder in 2005, with a 2007 update. This second update, in conjunction with the International Society for Bipolar Disorders (ISBD), reviews new evidence and is designed to be used in conjunction with the previous publications.

The recommendations for the management of acute mania remain mostly unchanged. Lithium, valproate, and several atypical antipsychotics continue to be first-line treatments for acute mania. Tamoxifen is now suggested as a third-line augmentation option. The combination of olanzapine and carbamazepine is not recommended. For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. New data support the use of adjunctive modafinil as a second-line option, but also indicate that aripiprazole should not be used as monotherapy for bipolar depression. Lithium, lamotrigine, valproate, and olanzapine continue to be first-line options for maintenance treatment of bipolar disorder. New data support the use of quetiapine monotherapy and adjunctive therapy for the prevention of manic and depressive events, aripiprazole monotherapy for the prevention of manic events, and risperidone long-acting injection monotherapy and adjunctive therapy, and adjunctive ziprasidone for the prevention of mood events.

Bipolar II disorder is frequently overlooked in treatment guidelines, but has an important clinical impact on patients’ lives. This update provides an expanded look at bipolar II disorder.

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