Skip to main content

20-08-2013 | Mental health | Article

Bipolar subtype upsets treatment guideline congruence


Free full text

medwireNews: Most patients with bipolar disorder are receiving treatment in line with current guidelines, Canadian researchers report, but the use of antidepressants during hypomanic episodes is a significant caveat.

The team found that treatment of 113 patients with bipolar disorder referred to tertiary care between 2006 and 2009 by community physicians was congruent with the 2009 Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for type and dose in 68% of cases.

“This percentage was quite high when compared with other studies,” Sabrina Paterniti and Jean-Claude Bisserbe, from the University of Ottawa in Ontario, note in BMCPsychiatry.

They say the findings “support the efficacy of efforts made over past years in attempting to communicate CANMAT guidelines.”

Despite this high rate of overall concordance, 68% of patients with hypomania received treatment nonconcordant with the guidelines.

Paterniti and Bisserbe report that in more than half of these patients, this was due to inappropriate antidepressant treatment, with 30.6% being given antidepressants without any mood stabilizer and 22.2% being given antidepressants during hypomanic episodes.

The researchers note that 10 of the 81 patients with bipolar II disorder were prescribed antidepressants in a hypomanic phase; six had “mixed” depressive symptoms and two had rapid cycling. “Antidepressant treatment is specifically contraindicated” for both conditions, they point out.

They recognize that this finding may arise from difficulties in diagnosing bipolar II disorder – particularly given patients commonly seek medical advice during depressive rather than hypomanic phases – patients not adhering to mood stabilizers, and the lack of consensus in the CANMAT guidelines on when to suspend antidepressant treatment after depressive episodes.

But they add that “there remains the possibility of general practitioners not following guidelines for lack of awareness, lack of agreement, or lack of familiarity.”

It seems that the “symptoms, rather than the disorder, are often the target for treatment,” the researchers report.

They recommend educational programs as the best means of “increasing the likelihood of general practitioners correctly assigning a subtype diagnosis in the treatment of [bipolar disorder], and prescribing mood stabilizers instead of antidepressants.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter