Canmat Guidelines

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Copyright ª Blackwell Munksgaard 2005 Bipolar Disorders 2005: 7(Suppl. 3): 5–69 BIPOLAR DISORDERS

Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies Yatham LN, Kennedy SH, O’Donovan C, Parikh S, MacQueen G, McIntyre R, Sharma V, Silverstone P, Alda M, Baruch P, Beaulieu S, Daigneault A, Milev R, Young T, Ravindran A, Schaffer A, Connolly M, Gorman CP. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord 2005: 7 (Suppl. 3): 5–69. ª Blackwell Munksgaard, 2005

Co-Chairs: Lakshmi N Yathama, Sidney H Kennedyb Section Leaders: Claire O’Donovanc, Sagar Parikhb, Glenda MacQueend, Roger McIntyreb, Verinder Sharmae, Peter Silverstonef Guidelines Committee: Martin Aldac, Philippe Baruchg, Serge Beaulieuh, Andree Daigneaulti, Roumen Milevj, L. Trevor Youngb, Arun Ravindranb, Ayal Schafferb, Mary Connollyk & Chris P Gormanl a

Since the previous publication of Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines in 1997, there has been a substantial increase in evidence-based treatment options for bipolar disorder. The present guidelines review the new evidence and use criteria to rate strength of evidence and incorporate effectiveness, safety, and tolerability data to determine global clinical recommendations for treatment of various phases of bipolar disorder. The guidelines suggest that although pharmacotherapy forms the cornerstone of management, utilization of adjunctive psychosocial treatments and incorporation of chronic disease management model involving a healthcare team are required in providing optimal management for patients with bipolar disorder. Lithium, valproate and several atypical antipsychotics are first-line treatments for acute mania. Bipolar depression and mixed states are frequently associated with suicidal acts; therefore assessment for suicide should always be an integral part of managing any bipolar patient. Lithium, lamotrigine or various combinations of antidepressant and mood-stabilizing agents are first-line treatments for bipolar depression. First-line options in the maintenance treatment of bipolar disorder are lithium, lamotrigine, valproate and olanzapine. Historical and symptom profiles help with treatment selection. With the growing recognition of bipolar II disorders, it is anticipated that a larger body of evidence will become available to guide treatment of this common and disabling condition. These guidelines also discuss issues related to bipolar disorder in women and those with comorbidity and include a section on safety and monitoring.

Department of Psychiatry, University of British Columbia, Vancouver, BC, bDepartment of Psychiatry, University of Toronto, Toronto, ON, c Department of Psychiatry, Dalhousie University, Halifax, NS, dMcMaster University, Hamilton, ON, e Department of Psychiatry, University of Western Ontario, ON, fDepartments of Psychiatry and Neuroscience, Alberta, Edmonton, AB, g Department of Psychiatry, Laval University, Quebec City, QC, hDepartment of Psychiatry, McGill University, Montreal, iDepartment of Psychiatry, University of Montreal, jDepartment of Psychiatry, Queen’s University, Kingston, ON, k Mood Disorders Service, Victoria, BC, lUniversity of Calgary, Calgary, AB, Canada

This project was supported by unrestricted educational grants from Lilly, AstraZeneca and Janssen-Ortho.

Section 1: Introduction

There has been an explosion of research into treatment of bipolar disorder since the publication

of the first guidelines for the treatment of bipolar disorder by the American Psychiatric Association in 1994 (1). Over the past decade, novel anticonvulsants (2), atypical antipsychotics (3), and

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psychosocial treatments (4, 5) have been widely studied for their efficacy in bipolar disorder. In order to...
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