Overview
Clinical Meaning
The clinician managing bipolar disorder prescribes mood stabilizer regimens, manages treatment resistant cases, navigates pregnancy planning, and coordinates long term maintenance.
The clinician managing bipolar disorder prescribes mood stabilizer regimens, manages treatment-resistant cases, navigates pregnancy planning, and coordinates long-term maintenance. The Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) guidelines provide evidence-based treatment algorithms. For acute mania: first-line monotherapy (lithium, valproic acid, quetiapine, risperidone, aripiprazole, paliperidone, asenapine, cariprazine); first-line combination (lithium or VPA + quetiapine, risperidone, aripiprazole, or asenapine). For bipolar depression: first-line (quetiapine, lurasidone + Li/VPA, lamotrigine, lithium, lurasidone monotherapy); adding an antidepressant is second-line and ONLY with mood stabilizer. For maintenance: lithium (strongest evidence for suicide prevention and long-term stabilization), quetiapine, lamotrigine (depression prevention), valproic acid (mania prevention in rapid cyclers). Treatment-resistant bipolar disorder may require: clozapine (most effective antipsychotic for refractory mania), ECT (effective for both acute mania and depression, safe in pregnancy), combination mood stabilizers (lithium + valproic acid + lamotrigine), or newer agents (cariprazine for bipolar depression). The clinician also manages the complex psychopharmacology of bipolar disorder in pregnancy: lithium (Ebstein anomaly 0.1-0.5%, requires fetal echo and third-trimester level monitoring), lamotrigine (safest mood stabilizer in pregnancy, but levels drop...