From the Research
The Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 guidelines for bipolar disorder management emphasize a stepped-care approach, with lithium remaining a crucial component due to its efficacy in preventing manic and depressive episodes and reducing suicide risk, as supported by the most recent evidence 1.
Key Recommendations
- First-line treatments for bipolar I depression include quetiapine, lurasidone, cariprazine, and lithium plus lamotrigine.
- For bipolar I mania, lithium, divalproex, and several atypical antipsychotics (aripiprazole, asenapine, cariprazine, olanzapine, quetiapine, risperidone, and ziprasidone) are recommended as first-line options.
- For maintenance treatment, lithium is the gold standard, with lamotrigine, quetiapine, and several other atypical antipsychotics also recommended.
- For bipolar II disorder, quetiapine and lithium are first-line treatments for depression, while lithium and lamotrigine are preferred for maintenance.
Importance of Lithium
Lithium's central role in bipolar management is due to its proven efficacy in preventing both manic and depressive episodes and reducing suicide risk, as highlighted in recent studies 1, 2.
Considerations for Treatment
Treatment should be individualized based on factors such as previous response, side effect profile, patient preference, and comorbidities, with an emphasis on psychosocial interventions alongside medication, including psychoeducation, cognitive behavioral therapy, and family-focused therapy 1.
Mortality Risk
Recent studies have shown that olanzapine and risperidone are associated with higher mortality risk than lithium, supporting the clinical guidelines recommending lithium as the first-line mood-stabilizer for bipolar disorder 3.