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The Role of Pharmacologic Treatment Guidelines for Bipolar Disorder

Roy H. Perlis, M.D.

With the growth in the number of pharmacologic options available for the treatment of bipolar disorder, clinicians face a challenge in appropriately selecting and sequencing newer and older treatments. Because evidence-based practice has been suggested as a way to improve outcomes across specialties in medicine, a number of practice guidelines and treatment algorithms for bipolar disorder have been developed to aid clinical decision-making. Most of these guidelines and algorithms are based on detailed reviews of the medical literature, with an emphasis on systematic reviews and randomized, controlled trials. Some guidelines incorporate a consensus of expert opinion when the literature does not provide clear evidence. This review examines areas of overlap and discordance in practice guidelines issued by the American Psychiatric Association and the British Association for Psychopharmacology, as well as treatment algorithms developed by the Expert Consensus Guideline Series and the Texas Medical Algorithm Project.

(J Clin Psychiatry 2005;66[suppl 3]:37–47)

From the Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston.

This article was derived from the teleconference "The Role of Atypical Antipsychotics in the Treatment of Bipolar Disorder," which was held July 29, 2004, and supported by an unrestricted educational grant from Pfizer Inc.

Corresponding author and reprints: Roy H. Perlis, M.D., Massachusetts General Hospital Bipolar Clinic and Research Program, 50 Staniford Street, 5th Floor, Boston, MA 02114 (e-mail: RPERLIS@PARTNERS.ORG).