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Canadian Network for Mood and Anxiety Treatments …

Guidelines UpdateCanadian Network for Mood and AnxietyTreatments (CANMAT) and InternationalSociety for bipolar disorders (ISBD)collaborative update of CANMAT guidelinesfor the management of patients with bipolardisorder: update 2013 Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M,O Donovan C, MacQueen G, McIntyre RS, Sharma V, Ravindran A,Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B,Birmaher B, Ha K, Nolen WA, Berk Network for Mood and Anxiety Treatments (CANMAT)and international society for bipolar disorders (ISBD) collaborativeupdate of CANMAT guidelines for the management of patientswith bipolar disorder: update Disord 2013: 15: 1 44.

International Society for Bipolar Disorders, reviews new evidence and ... as not-recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, ... risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder ...

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Transcription of Canadian Network for Mood and Anxiety Treatments …

1 Guidelines UpdateCanadian Network for Mood and AnxietyTreatments (CANMAT) and InternationalSociety for bipolar disorders (ISBD)collaborative update of CANMAT guidelinesfor the management of patients with bipolardisorder: update 2013 Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M,O Donovan C, MacQueen G, McIntyre RS, Sharma V, Ravindran A,Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B,Birmaher B, Ha K, Nolen WA, Berk Network for Mood and Anxiety Treatments (CANMAT)and international society for bipolar disorders (ISBD) collaborativeupdate of CANMAT guidelines for the management of patientswith bipolar disorder: update Disord 2013: 15: 1 44.

2 2012 John Wiley & Sons A by Blackwell Publishing Canadian Network for Mood and Anxiety Treatments publishedguidelines for the management of bipolar disorder in 2005, withupdates in 2007 and 2009. This third update, in conjunction with theInternational society for bipolar disorders , reviews new evidence andis designed to be used in conjunction with the previous recommendations for the management of acute mania remainlargely unchanged. Lithium, valproate, and several atypicalantipsychotic agents continue to be first-line Treatments for acutemania.

3 Monotherapy with asenapine, paliperidone extended release(ER), and divalproex ER, as well as adjunctive asenapine, have beenadded as first-line the management of bipolar depression, lithium, lamotrigine, andquetiapine monotherapy, as well as olanzapine plus selective serotoninreuptake inhibitor (SSRI), and lithium or divalproex plusSSRI bupropion remain first-line options. Lurasidone monotherapyand the combination of lurasidone or lamotrigine plus lithium ordivalproex have been added as a second-line options.

4 Ziprasidone aloneor as adjunctive therapy, and adjunctive levetiracetam have been addedas not-recommended options for the treatment of bipolar , lamotrigine, valproate, olanzapine, quetiapine,aripiprazole, risperidone long-acting injection, and adjunctiveziprasidone continue to be first-line options for maintenance treatmentof bipolar disorder. Asenapine alone or as adjunctive therapy have beenadded as third-line N Yathama, Sidney HKennedyb, Sagar V Parikhb, AyalSchafferb, Serge Beaulieuc, MartinAldad, Claire O Donovand, GlendaMacQueene, Roger S McIntyreb,Verinder Sharmaf, Arun Ravindranb,L Trevor Younga, Roumen Milevg,David J Bonda, Benicio N Freyh,Benjamin I Goldsteini, Beny Laferj,Boris Birmaherk, Kyooseob Hal,Willem A NolenmandMichael Berkn,odoi: words.

5 bipolar CANMAT depression guidelines mania treatmentReceived 1 April 2012, revised and accepted forpublication 30 September 2012 Corresponding author:Lakshmi N. Yatham, MBBS, FRCPC, MRCP sych (UK)Department of PsychiatryUniversity of British Columbia2255 Wesbrook MallVancouver, BC V6T 2A1 CanadaFax: 604-822-7922E-mail: for all authors are listed before the disorders 2013: 15: 1 44 2012 John Wiley and Sons A/SPublished by Blackwell Publishing DISORDERS1 Section 1. IntroductionIn 2005, the Canadian Network for Mood andAnxiety Treatments (CANMAT) published guide-lines for the management of bipolar disorder (BD)(1), followed by updates in early 2007 (2) and in2009 [in collaboration with the InternationalSociety for bipolar disorders (ISBD)] (3).

6 Thisupdate includes data published in 2009 throughearly 2012, and is designed to be used in conjunc-tion with the 2005 CANMAT guidelines andprevious updates (1 3).The purpose of this update is to add previouslyunpublished material to the guidelines. This updateis designed to be used with the previous iterations ofthe guidelines. As in the previous updates, the guide-lines are divided into eight sections (Table ) andthe same numbering system has been used for thesections and tables in order to facilitate ease of evidence is incorporated into the managementrecommendations, and changes to the recommen-dation tables have been clearly denoted withbolditalicsand a footnote, and have been describedin the text.

7 The objective is to ensure that theCANMAT guidelines for treatment of BD remaincurrent and useful for the practicing to this update are the tables showingfirst-line, second-line, third-line, and not-recom-mended treatment options. These tables may assistin the selection of treatment , while the text of thisupdate and the previous guideline iterationsprovide the details of the evidence that was usedto make the recommendations. Similarly, thetreatment algorithms condense key managementinformation into a decision-tree flow-chart; theclinician should begin by positioning the patient inthe decision tree, and then follow the arrows forsubsequent management strategies and methods to assess evidencewere as described in the original guidelines (1).

8 Evidence available only in abstract form was alsoconsidered in order to ensure that the recommen-dations are as up to date as possible. The criteriafor rating strength of evidence and making aclinical recommendation are shown in Tables caution the readers that the evidence-basedguidelines are limited by the data that are avail-able. For instance, drugs that have patents arelikely to have been more widely studied and theirdesign was likely influenced by the goals of thesponsor to obtain approval. Generic drugs,although may be useful, may not have been widelystudied because of lack of sponsorship, thusaffecting their placement in the treatment algo-rithm.

9 Finally, it is important to understand thatthe lack of evidence for a particular drug does notimply inefficacy or efficacy. Clinicians must exercisecaution and choose Treatments based on a carefulrisk benefit analysis for each 2. Foundations of managementEpidemiologyPrevalence. The World Mental Health SurveyInitiative, involving 61392 people in nine countriesin North and South America, Europe, and Asia,reported lifetime (and 12-month) prevalence esti-mates of ( ) for BD I, ( ) forBD II, and ( ) for subthreshold BD (4).

10 However, there were large cross-national differ-ences in rates, with the lifetime rates ranging from0 to 1% for BD I, 0 to for BD II, and for subthreshold the Canadian Community Health Survey Mental Health and Well-Being (CCHS ), theprevalence of BD was significantly lower amongTable Overview of guideline sectionsSection 1. IntroductionSection 2. Foundations of managementSection 3. Acute management of bipolar maniaSection 4. Acute management of bipolar depressionSection 5. Maintenance therapy for bipolar disorderSection 6.


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