Methodological differences between pharmacological treatment guidelines for bipolar disorder: what to do for the clinicians?

Objective: Numerous guidelines for bipolar disorder have been published. The aim of this article is to underline the main differences between consensus-based guidelines (CBG) and evidence-based guidelines (EBG) currently available for the management of bipolar disorder.

Methods: A literature search for guidelines published since 2006 was performed. A qualitative analysis was then conducted to compare the methodologies and the guidelines contents.

Results: Comparison between CBG and EBG found more similarities than differences. However, discordances were found in the first-line choice of treatment (monotherapy or combination, use of lamotrigine or lithium in bipolar depression), time to reassessment and duration of maintenance treatment, introduction as from the acute phase a regimen compatible with long-term use and pharmacotherapy during pregnancy.

Conclusions: The choice of policy, whatever the methodology used, is up to the authors and can, therefore, depend on their interpretation of the available scientific evidence. Combining both methodologies (CBG and EBG) enables us to meet the complete definition of evidence-based medicine.