Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology

doi:10.1177/0269881116636545

. 2016 Jun;30(6):495-553.

doi: 10.1177/0269881116636545. Epub 2016 Mar 15.

Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology

G M Goodwin¹, P M Haddad², I N Ferrier³, J K Aronson⁴, Trh Barnes⁵, A Cipriani⁶, D R Coghill⁷, S Fazel⁶, J R Geddes⁶, H Grunze⁸, E A Holmes⁹, O Howes¹⁰, S Hudson¹¹, N Hunt¹², I Jones¹³, I C Macmillan¹⁴, H McAllister-Williams³, D R Miklowitz¹⁵, R Morriss¹⁶, M Munafò¹⁷, C Paton¹⁸, B J Saharkian¹⁹, Kea Saunders⁶, Jma Sinclair²⁰, D Taylor²¹, E Vieta²², A H Young²³

Affiliations

¹ University Department of Psychiatry, Warneford Hospital, Oxford, UK guy.goodwin@psych.ox.ac.uk.
² Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK.
³ Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK.
⁴ Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK.
⁵ The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK.
⁶ University Department of Psychiatry, Warneford Hospital, Oxford, UK.
⁷ MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia.
⁸ Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria.
⁹ MRC Cognition & Brain Sciences Unit, Cambridge, UK.
¹⁰ Institute of Psychiatry (Box 67), London, UK.
¹¹ Bipolar UK, London, UK.
¹² Fulbourn Hospital, Cambridge, UK.
¹³ MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK.
¹⁴ Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK.
¹⁵ UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
¹⁶ Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK.
¹⁷ MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK.
¹⁸ Oxleas NHS Foundation Trust, Dartford, UK.
¹⁹ Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK.
²⁰ University Department of Psychiatry, Southampton, UK.
²¹ South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK.
²² Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
²³ Centre for Affective Disorders, King's College London, London, UK.

PMID: 26979387
PMCID: PMC4922419
DOI: 10.1177/0269881116636545

Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology

G M Goodwin et al. J Psychopharmacol. 2016 Jun.

. 2016 Jun;30(6):495-553.

doi: 10.1177/0269881116636545. Epub 2016 Mar 15.

Authors

Affiliations

¹ University Department of Psychiatry, Warneford Hospital, Oxford, UK guy.goodwin@psych.ox.ac.uk.
² Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK.
³ Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK.
⁴ Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK.
⁵ The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK.
⁶ University Department of Psychiatry, Warneford Hospital, Oxford, UK.
⁷ MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia.
⁸ Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria.
⁹ MRC Cognition & Brain Sciences Unit, Cambridge, UK.
¹⁰ Institute of Psychiatry (Box 67), London, UK.
¹¹ Bipolar UK, London, UK.
¹² Fulbourn Hospital, Cambridge, UK.
¹³ MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK.
¹⁴ Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK.
¹⁵ UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
¹⁶ Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK.
¹⁷ MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK.
¹⁸ Oxleas NHS Foundation Trust, Dartford, UK.
¹⁹ Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK.
²⁰ University Department of Psychiatry, Southampton, UK.
²¹ South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK.
²² Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
²³ Centre for Affective Disorders, King's College London, London, UK.

PMID: 26979387
PMCID: PMC4922419
DOI: 10.1177/0269881116636545

Abstract

The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.

Keywords: Bipolar disorder; antidepressants; antipsychotics; cognitive behaviour therapy; evidence-based guidelines; lithium; mood stabilizers; psychoeducation; treatment.

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Conflict of interest statement

For disclosure of competing interests for all authors, visit http://www.bap.org.uk

Figures

**Figure 1. The problem for early detection of bipolar disorder.**
Adapted from (Berk et al., 2007).

See this image and copyright information in PMC

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References

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[1] Abdallah CG, Sanacora G, Duman RS, et al. Ketamine and rapid-acting antidepressants: a window into a new neurobiology for mood disorder therapeutics. Annual review of medicine. 2015;66:509–523. - PMC - PubMed

[2] Abdallah CG, Sanacora G, Duman RS, et al. Ketamine and rapid-acting antidepressants: a window into a new neurobiology for mood disorder therapeutics. Annual review of medicine. 2015;66:509–523. - PMC - PubMed

[3] Achtyes ED, Halstead S, Smart L, et al. Validation of Computerized Adaptive Testing in an Outpatient Nonacademic Setting: The VOCATIONS Trial. Psychiatr Serv. 2015;66:1091–1096. - PMC - PubMed

[4] Achtyes ED, Halstead S, Smart L, et al. Validation of Computerized Adaptive Testing in an Outpatient Nonacademic Setting: The VOCATIONS Trial. Psychiatr Serv. 2015;66:1091–1096. - PMC - PubMed

[5] Albert U, Rosso G, Maina G, et al. Impact of anxiety disorder comorbidity on quality of life in euthymic bipolar disorder patients: differences between bipolar I and II subtypes. Journal of Affective Disorders. 2008;105:297–303. - PubMed

[6] Albert U, Rosso G, Maina G, et al. Impact of anxiety disorder comorbidity on quality of life in euthymic bipolar disorder patients: differences between bipolar I and II subtypes. Journal of Affective Disorders. 2008;105:297–303. - PubMed

[7] Allen MH, Currier GW, Hughes DH, et al. The Expert Consensus Guideline Series. Treatment of behavioral emergencies. PostgradMed. 2001:1–88. - PubMed

[8] Allen MH, Currier GW, Hughes DH, et al. The Expert Consensus Guideline Series. Treatment of behavioral emergencies. PostgradMed. 2001:1–88. - PubMed

[9] Altshuler L, Kiriakos L, Calcagno J, et al. The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression: a retrospective chart review. J Clin Psychiatry. 2001;62:612–616. - PubMed

[10] Altshuler L, Kiriakos L, Calcagno J, et al. The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression: a retrospective chart review. J Clin Psychiatry. 2001;62:612–616. - PubMed

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Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology

Affiliations

Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology

Authors

Affiliations

Abstract

Conflict of interest statement

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Conflict of interest statement

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