Bipolar Depression Treatment Guideline Updates

FLORIDA BEST PRACTICE PSYCHOTHERAPEUTIC MEDICATION GUIDELINES FOR ADULTS WERE UPDATED IN 20201
An Expert Panel* has met biennially since 2005 to review and update the Florida Medicaid guidelines
  • For each disorder, a nationally recognized expert psychiatrist conducts a full literature review and makes suggestions on revising the guidelines based on the scientific evidence
  • The panel discusses and reaches a consensus on the guidelines and proposed revisions
  • With evidence-based recommendations for prescribing psychotherapeutic medication to treat bipolar depression, major depressive disorder, and schizophrenia, the guidelines aim to inform and support clinicians in making safe and evidencebased treatment decisions that maximize benefit and minimize harm to patients
Final guidelines are the product of an in-depth literature review, with emphasis on efficacy, safety, level of clinical evidence, and expert consensus on the strength of the evidence
*Expert Panel was composed of nationally recognized experts, academics, medical directors of Florida Medicaid MMA health plans & CMHCs, psychiatrists, primary care providers, and pharmacists.

Recommendations for Bipolar Depression from the 2020 Florida Best Practice Psychotherapeutic Medication Guidelines1

​2020 Florida Best Practice Pyschotherapeutic Medication Guidelines

​FDA=Food and Drug Administration; LAI=long-acting injectable; MAOI=monoamine oxidase inhibitor; RCT=randomized controlled trial; SGA=second generation antipsychotic; SNRI=serotonin and norepinephrine reuptake inhibitor; SSRI=selective serotonin reuptake inhibitor; TCA=tricyclic antidepressants

HIGHLIGHTS FROM THE 2020 FLORIDA BEST PRACTICE PSYCHOTHERAPEUTIC MEDICATION GUIDELINES FOR BIPOLAR DEPRESSION1
  • Lurasidone monotherapy remains recommended as Level 1 treatment for bipolar depressionCariprazine recommended as Level 1 treatment for bipolar depression. 
  • Cariprazine recommended as an alternative adjunct therapy even though adjunctive data for cariprazine in this setting are not available
  • Noted that lurasidone and cariprazine have better metabolic profiles than quetiapine
  • Quetiapine recommended as Level 1 treatment only for patients with bipolar II depression
  • Lithium monotherapy (although it does not yet have FDA approval) recommended as Level 1 treatment for bipolar depression

Recent CANMAT and ISBD Guidelines
CANADIAN NETWORK FOR MOOD AND ANXIETY TREATMENTS (CANMAT) AND INTERNATIONAL SOCIETY FOR BIPOLAR DISORDER (ISBD) GUIDELINES WERE UPDATED IN 20182
2018 CANMAT and ISBD Guidelines
  • A comprehensive, up-to-date review of research evidence on the treatment of the various phases of bipolar disorder
  • With global representation of experts in psychiatry, the goal of the guidelines is to be a source of clear, easy to use recommendations for the improvement of outcomes in patients with bipolar disorder 
New hierarchical ranking of first- and second-line recommendations for acute mania, depression, and maintenance treatment of bipolar I disorder, based on:
  • Efficacy across all phases of bipolar disorder I*
  • Acute and maintenance safety and tolerability
  • Risk for treatment-emergent switch
*The recommendation is for acute mania, depression, and maintenance treatment of bipolar I disorder.

2018 CANMAT and ISBD Treatment Recommendations for Bipolar Disorder2