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

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.

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

“…During this time period, CANMAT has strived to translate advances in research into international consensus on evidence‐based clinical management; first by publishing 2005 guidelines accompanied by expert commentaries, then by providing updates in 2007,2 20093 and 20134 in collaboration with the International Society for Bipolar Disorders (ISBD). The main objective of these publications was to synthesize the wealth of evidence on the efficacy, safety, and tolerability of the range of interventions available for this complex and varied illness, with the goal of providing clear, easy to use recommendations for clinicians to improve outcomes in their patients.…”

Effect of lamotrigine and carbamazepine on corticotropin-releasing factor-associated serotonergic transmission in rat dorsal raphe nucleus

“…The drugs carbamazepine (CBZ) and lamotrigine (LTG) have wide-ranging antiepileptic (Marson et al 2007a, b;Mattson 2002) and mood-stabilizing activities (Yatham et al 2009). Inhibition of voltage-gated sodium channels is the major mechanism underlying the antiepileptic actions of CBZ and LTG (Drizin et al 2008;McLean and Macdonald 1986;Xie et al 2001) and possibly also their moodstabilizing activities (Amann et al 2011;Geddes et al 2009;Kawata et al 2001;Mirza et al 2005).…”

“…Inhibition of voltage-gated sodium channels is the major mechanism underlying the antiepileptic actions of CBZ and LTG (Drizin et al 2008;McLean and Macdonald 1986;Xie et al 2001) and possibly also their moodstabilizing activities (Amann et al 2011;Geddes et al 2009;Kawata et al 2001;Mirza et al 2005). Clinical studies have demonstrated the efficacies of both CBZ and LTG in patients with bipolar disorders; however, the moodstabilizing spectra between CBZ and LTG are probably different (El-Mallakh et al 2010;Yatham et al 2009). The efficacy of CBZ in patients with acute mania is well established; however, it has little effect against bipolar depression (El-Mallakh et al 2010;Yatham et al 2009).…”

Ziprasidone in the Treatment of Bipolar Disorder

“…The Canadian guidelines also were revised in 2009 (Yatham et al, 2009). Ziprasidone is listed as a first line anti-manic agent, comparable to lithium, divalproex, and other SGAs.…”