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New Guidelines Help in Diagnosis and Treatment of Bipolar Disorder WHITE PLAINS, NY -- April 14, 2000 -- Leading psychiatrists and researchers have compiled years of clinical experience and data to create a reference tool that will better help physicians select the best treatment for bipolar disorder, one of the most challenging mental illnesses to diagnose and treat. The new guidelines, Medication Treatment of Bipolar Disorder 2000, published in the April Postgraduate Medicine Special Report, represent a consensus of more than 50 leading experts in psychiatry. The guidelines are based on clinical experience as well as knowledge of the published data, and are a result of proven experience by the psychiatric community. "On average, people with bipolar disorder see three to four doctors before they receive a correct diagnosis," said Gary S. Sachs, MD, director of Partners Bipolar Treatment Center, Massachusetts General Hospital, and assistant professor of psychiatry, Harvard Medical School. "One reason the new guidelines will prove to be so useful is that once the correct diagnosis is made, appropriate treatment can be determined to better help patients manage their symptoms of bipolar disorder." Designed to be easy to follow and use, the guidelines also will help identify and appropriately treat bipolar disorder. The guidelines can be used as a "virtual consult," making the clinical experience of leading psychiatrists and relevant data available in every doctor's office. "With these guidelines in their offices, all doctors will have useful information to help them make important diagnosis and treatment decisions," said John P. Docherty, MD, adjunct professor of psychiatry, Weill Medical College of Cornell. "Years of experience are behind the guidelines, and physicians can rely on this tool to provide up-to-date information." In 1996, the first expert consensus guidelines were created for the medication treatment of bipolar disorder, but new research and the introduction of new treatments made a revision necessary. The sheer number of potentially useful medications makes clinical decisions more complex, and the revised guidelines help bridge the gap between the research and evidence and the key clinical decisions. To compile a new set of treatment guidelines, a written survey was formed from peer-reviewed literature, and asked about 1,276 options for psycho-pharmacologic interventions in 48 specific clinical situations. The panel highlighted important clinical questions that had not yet been adequately addressed or definitely answered. The questions asked about appropriateness of treatment in specific situations from a scale of one (extremely inappropriate) to nine (extremely appropriate), and ranged from broad strategies, such as classes of medication, to tactics, such as specific medication selection and dosing. The survey was conducted among national experts -- authors of important publications, recipients of research grants, and members of the American Psychiatric Association task forces for bipolar disorder. A review of the survey results found that a consensus was reached on 89 percent of the key strategies, and the panel came up with four key recommendations. The primary recommendations are: -- use a mood stabilizer in all phases of treatment -- divalproex sodium (Depakote(R)) and lithium are the cornerstone choices for both acute-phase and preventive treatment -- mood stabilizers should be tried first when monotherapy is desired, in combination when either has failed, and as the bedrock upon which other medications may be layered Other recommendations include: -- mania or depression with rapid cycling should be treated initially with a mood stabilizer alone, preferably divalproex sodium for either phase -- atypical antipsychotics, such as olanzapine and risperidone, are generally preferred over the older, so-called "typical" antipsychotics as adjunct treatment when psychosis accompanies mania or depression -- mild depression should be treated with mood stabilizer monotherapy initially, while severe depressions should be treated from the start with an antidepressant plus a mood stabilizer The impact of bipolar disorder on families and friends can be tremendous, and they often are uncertain about the illness and how to treat it. "Treatment of Bipolar Disorder: A Guide for Patients and Families," a section within the guidelines, answers some of the most commonly asked questions about bipolar disorder in everyday language. This section explains symptoms, causes, treatments, and medications for bipolar disorder, and also gives suggestions for other references on bipolar disorder. "Bipolar disorder is a serious, potentially fatal illness. Although effective treatments exist, there is an average lapse of eight years from onset of symptoms to treatment. These guidelines will help physicians accurately diagnose the illness and meet the critical need for appropriate treatment," said Lydia Lewis, executive director of the National Depressive and Manic-Depressive Association. Bipolar disorder (also known as manic-depressive illness) is a biologically-based mood disorder that affects more than 2.2 million people in the United States. Symptoms and severity vary, but the disorder is marked by mood changes in cycles over time. Over the course of the illness, the person experiences periods of elevated mood, periods of depressed mood, and times when mood is normal. E-mail this page to a friend or colleague! To print, use this version