Florida Best Practice Psychotherapeutic Medication Guidelines for Adults With Bipolar Disorder: A Novel, Practical, Patient-Centered Guide for Clinicians

Objective: This report describes the 2014 update of the Florida Best Practice Psychotherapeutic Medication Guidelines for Adults With Bipolar Disorder, intended to provide frontline clinicians with a simple, evidence-based approach to treatments for 3 phases of bipolar disorder: acute depression, acute mania, and maintenance.

Participants: The consensus meeting included representatives from the Florida Agency for Health Care Administration, pharmacists, health care policy experts, mental health clinicians, and experts in bipolar disorder. The effort was funded by the Florida Agency for Health Care Administration.

Evidence: The available published and nonpublished data from trials in the treatment of bipolar I disorder were reviewed. Evidence for efficacy and harm from replicated randomized clinical trials, systematic reviews and meta-analyses, or non-replicated randomized clinical trials was included. No recommendations were made with evidence from other sources.

Consensus process: Decisions regarding the structure of the guidelines were made during a stakeholder meeting in Tampa, Florida, on September 20 and 21, 2013. Better proven and safer/more efficacious treatments were to be utilized before using those with less evidence and/or greater risk. Safety and risk of harm were balanced against potential benefit. Lower-quality evidence was recommended only if higher-level treatments were found to be ineffective or not tolerated, because of patient preference, or because of past treatment success. While respecting patient and clinician choice, the guidelines are structured to encourage evidence-based, safe prescribing first.

Conclusions: This iteration of the Florida guidelines for the treatment of bipolar disorder is a practical, simple, patient-focused guide to treatment for acute mania and acute bipolar depression and maintenance treatment that considers safety and harm in the hierarchy of treatment choices. While using strict evidence-based criteria for inclusion in recommendations, it eliminates expert opinion as a level of evidence while respecting clinician and patient choice in treatment decision-making.