Bipolar disorder guideline registry¶
Last verified: 2026-10-23
This registry catalogs documents; synthesis and clinical comparison belong in wiki/guidelines.md. “Current” means no superseding document was identified in this session, not that every recommendation remains current.
Master table¶
| Body | Year | Region | Scope | Citation / live source | Status / dated provenance |
|---|---|---|---|---|---|
| CANMAT / ISBD | 2018 | Canada / international | Comprehensive bipolar management | Yatham et al., PMID 29536616 | Current base document; supplemented by 2023 update |
| CANMAT / ISBD | 2023 | Canada / international | Summary and evidence update | Keramatian et al., PMID 38695002 | Current supplement; not a complete section-by-section replacement |
| CANMAT / ISBD | 2021 | Canada / international | Mixed presentations | Yatham et al., PMID 34599629 | Topic supplement; DSM-5 recommendations lower-ranked than older DSM-IV mixed-episode recommendations |
| NICE CG185 | 2014, updated 2025 | England and Wales | Recognition, acute and long-term management, children and adults | https://www.nice.org.uk/guidance/cg185, accessed 2026-08-30 | Current; page states last updated 2 Sep 2025 |
| VA / DoD | 2023 | United States | Adult bipolar management | https://healthquality.va.gov/HEALTHQUALITY/guidelines/mh/bd/index.asp, accessed 2026-08-30; synopsis PMID 39832345 | Current US federal guideline |
| APA | 2002 | United States | Comprehensive treatment | https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar-1410197656063.pdf, accessed 2026-08-30 | Historical; hosted PDF explicitly says it cannot be assumed current |
| APA Guideline Watch | 2005 | United States | New evidence after 2002 guideline | https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar-watch-1410457042123.pdf, accessed 2026-08-30 | Historical supplement |
| British Association for Psychopharmacology | 2016 | United Kingdom | Evidence-based biological and psychosocial treatment | Goodwin et al., PMID 26979387 | Current BAP bipolar edition found; aging |
| RANZCP | 2020 | Australia / New Zealand | Mood disorders including bipolar disorder | Malhi et al., PMID 33353391; https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/mood-disorders-cpg, accessed 2026-08-30 | Society labels it >5 years old and no longer current |
| CINP | 2017 | International | Methods, evidence grading, algorithm and clinical guidance | PMIDs: 27815414, 27816941, 27941079 | Current CINP bipolar series found; aging |
| WFSBP | 2013 | International | Long-term biological treatment | Grunze et al., PMID 23480132 | Topic-specific; aging |
| WFSBP | 2018 | International | Acute and long-term mixed states | Grunze et al., PMID 29098925 | Topic-specific current document found |
| JSMD | 2023 / English paper 2024 | Japan | Practice guideline: pharmacotherapy, psychosocial, perinatal, monitoring | Kato et al., PMID 39194164; https://www.secretariat.ne.jp/jsmd/iinkai/katsudou/kibun.html, accessed 2026-08-30 | Current; supersedes JSMD 2020 treatment guideline |
| Japanese Society of Clinical Neuropsychopharmacology | 2020 | Japan | Pharmacological expert consensus | Sakurai et al., PMID 32558145 | Supplementary expert consensus; not the current JSMD practice guideline |
| Chinese guideline | 2018 | China | Principal assessment and management summary | Wang et al., PMID 29604156 | Latest PubMed-indexed national summary found; currency unconfirmed |
| Indian Psychiatric Society | 2025 update / paper 2026 | India | Adult bipolar management | Menon et al., PMID 41694044 | Current adult update; supersedes 2017 adult document |
| Indian Psychiatric Society | 2017 | India | Adult bipolar management | Shah et al., PMID 28216785 | Superseded by 2025 update |
| Indian Psychiatric Society | 2019 | India | Child and adolescent bipolar disorder | Gautam et al., PMID 30745704 | Pediatric topic document |
| Taiwan consensus | 2022 / paper 2023 | Taiwan | Acute, maintenance and mixed phases | Cheng et al., PMID 36724568 | Current update found |
| Korean Medication Algorithm Project | 2018 edition / comparison 2020 | South Korea | Expert medication algorithm | Jon et al., PMID 32202033 | Fifth edition described; check for newer edition |
| CANMAT/WFSBP taskforce | 2022 | International | Nutraceuticals/phytoceuticals across psychiatric disorders | Sarris et al., PMID 35311615 | Special-purpose adjunct, not core bipolar guideline |
| International expert consensus | 2016 | International | Psychiatric agitation including bipolar disorder | Garriga et al., PMID 26912127 | Special-purpose emergency adjunct |
| ACOG | 2023 | United States | Mental-health treatment during pregnancy/postpartum | ACOG, PMID 37486661 | Current reproductive-health adjunct |
| ACOG | 2023 | United States | Perinatal screening and diagnosis, including bipolar disorder and postpartum psychosis | ACOG, PMID 37486660 | Current; modified GRADE plus ungraded good-practice points |
| AWMF S3 / BipolarLiving | Update registered 2025 | Germany | Diagnosis and treatment | https://www.awmf.org/aktuelles/awmf-aktuell/diagnostik-und-therapie-bipolarer-stoerungen-bipolarliving, accessed 2026-08-30; re-fetched 2026-10-09 (still "Anmeldung", version 2.1) | Prior guideline validity ended 31 May 2026; version 2.1 update project registered, not yet a completed replacement |
| ISBD Task Force on TRBD | 2025; correction 2026 | International | Consensus definition of treatment-resistant bipolar depression | Vieta et al., PMID 40808269; correction PMID 42478728 | Current special-purpose definition; correction content not retrievable (Wiley) |
| ISBD Chronobiology and Chronotherapy Task Force | 2025 | International | Bright light therapy recommendations | Geoffroy et al., PMID 40705857 | Current special-purpose recommendation; added 2026-10-09 (published before this registry's last check, missed then) |
| ISBD Chronobiology and Chronotherapy Task Force | 2026 | International | Delphi consensus on essential chronobiology/chronotherapy knowledge | Crouse et al., PMID 42429210 | Current educational consensus, not a graded treatment guideline |
| ISBD Staging Task Force | 2026 | International | Integrated three-dimensional clinical staging model | Kupka et al., PMID 42310905 | Current consensus framework; unvalidated prognostically |
| ISBD Older Adults with Bipolar Disorder task force | 2026 | International | Implementation of lower maintenance lithium ranges in laboratory reporting | Shulman et al., PMID 42489486 | Implementation initiative building on earlier ISBD Delphi recommendations |
| Polish Psychiatric Association | 2026 | Poland | Two-part antipsychotic metabolic-risk recommendations; includes mood disorders | Wichniak et al., PMID 42857933; PMID 42857934 | Updated specialty safety guidance; supplements bipolar treatment guidelines |
| ISBD Nutrition and Exercise Task Force (NExT) | 2026 | International | Physical activity and sedentary behavior; best-evidence synthesis | Lafer et al., PMID 42545207 | Special-purpose position statement. Searches through 1 March 2026. Limited high-quality bipolar trials; conclusion describes promising benefits and calls for multicenter RCTs. PMC-live 4 August 2026, backfilled 2026-10-23 |
| ISBD task force, lithium in older adults | 2026 | International | Observed lithium levels and toxicity thresholds in older adults | Nunes et al., PMID 42460615 | Systematic review of 14 observational studies (8,808 adults). Distinct from the Shulman implementation report (PMID 42489486). Authors say findings are consistent with age-adjusted targets. PMC-release 16 July 2026, backfilled 2026-10-23 |
| ISBD Vascular Task Force | 2026 | International | Research agenda for brain and body vascular imaging | Mio et al., PMID 42249599 | Review whose stated purpose is to guide vascular-imaging research. Abstract read; full text not retrieved, so no imaging metric was imported. June 2026, backfilled 2026-10-23 |
Per-guideline notes¶
CANMAT / ISBD 2018 and 2023¶
- Full citation: Yatham LN, et al. Canadian Network for Mood and Anxiety Treatments and International Society for Bipolar Disorders 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20:97-170. PMID 29536616.
- Scope: diagnosis, acute mania, bipolar depression, maintenance and special populations.
- Contribution: integrated hierarchical recommendations combining efficacy, safety/tolerability and clinical experience.
- Update relationship: Keramatian et al. summarize the 2018 framework and update evidence through 2023; use both rather than treating the shorter paper as a wholesale replacement (PMID 38695002).
- Status: current core international reference in this registry.
- Mixed-presentations supplement: no agent reached first line for DSM-5 mania or depression with mixed features; second-line options were asenapine, cariprazine, divalproex and aripiprazole for mania, and cariprazine and lurasidone for depression. DSM-IV mixed episodes retained first-line asenapine/aripiprazole because the evidence populations differ (Yatham et al., PMID 34599629).
NICE CG185¶
- Title: Bipolar disorder: assessment and management.
- Published 24 September 2014; official page reports last update 2 September 2025.
- Scope: bipolar I, bipolar II, mixed affective and rapid-cycling disorders in children, young people and adults.
- Distinctive structure: recognition/referral, crisis and risk, physical-health monitoring and UK service pathways.
- URL: https://www.nice.org.uk/guidance/cg185 (accessed 2026-08-30).
- Status: current; retain version date with every extracted recommendation.
VA / DoD 2023¶
- Official title: Management of Bipolar Disorder (BD) (2023).
- Official source: https://healthquality.va.gov/HEALTHQUALITY/guidelines/mh/bd/index.asp (accessed 2026-08-30).
- Published synopsis: Ostacher MJ, et al. J Clin Psychiatry. 2025;86:24cs15546. PMID 39832345.
- Primary-care summary: Arnold MJ. Am Fam Physician. 2024;109:585-587. PMID 38905567.
- Status: current US federal guideline; evidence grading resides in the full CPG.
APA 2002 and 2005 Guideline Watch¶
- The official hosted 2002 second-edition PDF states that it is more than five years old and cannot be assumed current.
- The 2005 Guideline Watch adds evidence but explicitly is not a formal full update.
- Chain: APA 2002 → supplemented by 2005 Guideline Watch → no current replacement verified.
- Status: historical/provenance only; do not use as a current recommendation without newer corroboration.
British Association for Psychopharmacology 2016¶
- Full citation: Goodwin GM, et al. Evidence-based guidelines for treating bipolar disorder: revised third edition. J Psychopharmacol. 2016;30:495-553. PMID 26979387.
- Official BAP page: https://www.bap.org.uk/docdetails.php?docID=6 (accessed 2026-08-30).
- Scope: acute and long-term pharmacologic and psychosocial treatment.
- Chain: earlier BAP editions → 2016 revised third edition.
- Status: influential and not superseded on the BAP page found, but aging.
RANZCP 2020¶
- Full citation: Malhi GS, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry. 2021;55:7-117. PMID 33353391.
- Official page states the guideline is more than five years old and “no longer considered current guidance.”
- Chain: 2015 mood-disorders CPG → 2020 update → replacement pending.
- Status: historical/recent reference, not current by issuing society's own label.
CINP-BD 2017¶
- Part 1: background and methods. PMID 27815414.
- Part 2: systematic review, evidence grading and algorithm. PMID 27816941.
- Part 3: clinical guidelines. PMID 27941079.
- The three papers are one package; citing only Part 3 loses the grading method.
- Status: latest CINP bipolar guideline series found; aging.
WFSBP topic guidelines¶
- Long-term treatment update 2012, published 2013: Grunze et al., PMID 23480132.
- Mixed states, acute and long term, published 2018: Grunze et al., PMID 29098925.
- These are topic documents, not one current comprehensive bipolar guideline.
- Status: use for their declared topics and preserve publication year.
Japanese Society of Mood Disorders¶
- Official society page lists the 2023 Practice Guideline for Bipolar Disorder and an English version.
- English indexed article: Kato T, et al. Psychiatry Clin Neurosci. 2024;78:633-645. PMID 39194164.
- Chain: 2011 initial treatment guideline → revisions through June 2020 → 2023 practice guideline.
- A publisher correction to the English paper was indexed on 2026-09-21 (Psychiatry Clin Neurosci, doi:10.1111/pcn.70135, PMID 42768410; Crossref
update-to: correction). Its content was not retrievable, so whether it changes any recommendation is unknown. - Status: current Japanese society guideline.
ISBD task-force consensus documents (added 2026-10-09)¶
- TRBD definition (Vieta et al., Bipolar Disord. 2025;27:411-423, PMID 40808269): failure of a significant, sustained response after ≥2 approved, adequately dosed treatments of sufficient duration with adherence. Bipolar I options are quetiapine 300–600 mg ≥8 weeks, lurasidone 20–120 mg ≥6 weeks, olanzapine–fluoxetine ≥8 weeks, cariprazine 1.5–3 mg ≥6 weeks and lumateperone 42 mg ≥6 weeks. Bipolar II options are quetiapine and lumateperone. A publisher correction (Bipolar Disord. 2026;28:e70165, PMID 42478728; Crossref
updated-by: correction, 2026-07-21) exists, but its text was not retrievable. - Bright light therapy (Geoffroy et al., Dialogues Clin Neurosci. 2025;27:249-264, PMID 40705857): adjunctive light is likely efficacious for acute bipolar depression. Use morning or mid-day timing and target 30 min/day, with optional titration from 15 min/day. Antimanic prophylaxis and monitoring are recommended. Maintenance use is not yet established.
- Chronobiology Delphi (Crouse et al., Bipolar Disord. 2026;28:e70141, PMID 42429210): 30 experts from 15 countries reached consensus on 342 of 837 statements. PubMed lists it as an update of a medRxiv preprint (PMID 40585074), which is not separately catalogued here.
- Staging (Kupka et al., Bipolar Disord. 2026;28:e70136, PMID 42310905): mood M0–M4, non-mood N0–N4 and function F0–F4, each rated independently.
- Older-adult lithium ranges (Shulman et al., Curr Opin Psychiatry. 2026;39:406-411, PMID 42489486): target 0.4–0.8 mmol/L at ages 60–79 and 0.4–0.7 mmol/L at ≥80. Eighteen dissemination attempts produced three implementations.
- Status: all five are consensus or implementation documents. Use them for definitions and targets, not as evidence grades.
China, India, Taiwan and South Korea¶
- China: the 2018 principal summary is PubMed-indexed (Wang et al., PMID 29604156); full-document current status needs a national-site check.
- India: the adult 2025 update (Menon et al., PMID 41694044) supersedes the 2017 adult document; the child/adolescent 2019 guideline remains a separate pediatric topic document (Gautam et al., PMID 30745704).
- Taiwan: 2022 consensus update covers acute, maintenance and mixed phases (Cheng et al., PMID 36724568).
- South Korea: the 2020 paper traces changes across 16 years and five KMAP-BP editions (Jon et al., PMID 32202033); search for a sixth edition at next sweep.
Disagreements and gaps¶
| Issue | Document-level disagreement / gap |
|---|---|
| Bipolar-depression sequencing | International comparison finds less agreement than for mania; newer antipsychotics and local licensing shift rankings (Parker et al., PMID 28260229; Park et al., PMID 38586960) |
| Adjunctive antidepressants | Guidelines vary in how narrowly they permit use, but antidepressant monotherapy in bipolar I is broadly rejected |
| Maintenance ranking | Lithium remains central; relative placement of antipsychotics, lamotrigine and valproate depends on polarity and safety weighting |
| Mixed features | WFSBP and Taiwan have explicit mixed-state frameworks; definitions and evidence populations differ across eras |
| Mixed-feature grading | CANMAT/ISBD assigns no first-line agent to DSM-5 mixed presentations, but assigns first-line asenapine/aripiprazole to DSM-IV mixed episodes; phenotype definition changes the evidence tier (PMID 34599629) |
| Rapid cycling | NICE applies the same interventions because of insufficient evidence for a separate pathway; other algorithms discuss additional cautions |
| Reproductive risk | National regulator restrictions evolve faster than full psychiatric guideline cycles; ACOG and current regulator material must supplement older documents |
| Evidence-grade visibility | ACOG labels modified-GRADE recommendations and ungraded good-practice points; older qualitative guideline systems such as BAP use different evidence-strength categories, so ranks are not directly interchangeable (PMIDs: 37486660, 19329543) |
| Children/adolescents | Far fewer trials; adult recommendations cannot be assumed transferable |
| Biomarkers/digital phenotyping | A live 2026-08-30 search of retrieved guideline texts found no routine molecular, polygenic or passive-sensing diagnostic/treatment-selection rule; the 2025 Indian update discusses internet-based self-management but notes limited real-world evidence |
| Patient-important harms | Cognition, sexual function, work and monitoring burden are inconsistently weighted |
| Implementation | Guideline concordance and access to recommended psychotherapy/monitoring remain separate from recommendation quality |
Superseded and supplement chains¶
| Chain | Registry interpretation |
|---|---|
| CANMAT earlier editions → CANMAT/ISBD 2018 → supplemented by 2023 evidence update | Use 2018 detail plus 2023 update |
| NICE predecessor guidance → CG185 2014 → amendments through 2025 | Use live recommendation page and version date |
| APA 2002 → 2005 Guideline Watch → no replacement verified | Historical only |
| BAP earlier editions → 2016 third edition | 2016 is latest BAP bipolar document found |
| RANZCP 2015 → RANZCP 2020 → replacement pending | 2020 explicitly not current per society |
| JSMD 2011 → JSMD 2020 revision → JSMD 2023 practice guideline | 2023 is current |
| Taiwan earlier consensus → 2022 update (published 2023) | Use 2022 update |
| KMAP-BP five editions through 2018 | Check for post-2018 edition |
| Indian Psychiatric Society adult 2017 → 2025 update (published 2026) | Use 2025 update for adult management; retain 2017 for provenance |
| German AWMF prior S3 guideline → version 2.1 update registered May 2025 | Prior validity ended 31 May 2026; await completed replacement |
Watch list¶
- New APA bipolar guideline replacing the 2002/2005 documents.
- Full CANMAT/ISBD replacement or new focused updates after 2023.
- NICE surveillance changes after the September 2025 update.
- Replacement RANZCP mood-disorders guideline.
- New BAP bipolar edition after 2016.
- Updated WFSBP long-term guideline after the 2013 publication.
- New CINP algorithm after 2017.
- New Chinese national full guideline and English summary.
- Implementation evidence and revisions following the Indian 2025 adult update.
- Sixth or later Korean Medication Algorithm Project edition.
- Regulatory changes for valproate and other reproductive-risk medicines in each region.
- Any guideline adoption of digital prediction, biomarker testing or patient-governed monitoring.
- Completion of the registered German AWMF S3/BipolarLiving version 2.1 update.
- Content of the 2026 corrections to the ISBD TRBD definition (PMID 42478728) and to the JSMD English paper (PMID 42768410).
- Systematic backfill of other ISBD task-force and society consensus documents indexed in 2025–2026. The 2026-10-09 title search (bipolar[ti] AND guideline/consensus/recommendation[ti], 2026 publication dates) returned 18 records. The five documents above were catalogued; disease-adjacent items (specialty-clinic set-up consensus, affective/social-cognition measurement consensus, postpartum-psychosis classification consensus, lurasidone Asian expert consensus) were screened but not catalogued. 2026-10-23: a follow-up PubMed title search for ISBD consensus records returned 14 PMIDs. Three previously uncatalogued task-force documents were added (NExT, the older-adult lithium systematic review, and the vascular-imaging research agenda). Previously declined items in that set stay declined, including the cognition-measures consensus (PMID 41703784), the pro-cognitive intervention review (PMID 41083219), the psychosocial-guidelines review (PMID 40411321) and the chatbot commentary (PMID 42274191). Shulman (PMID 42489486) was already catalogued and is distinct from Nunes (PMID 42460615).
Search provenance¶
PubMed E-utilities searches in this session included bipolar disorder with guideline/guidelines/consensus title terms; targeted WFSBP, CINP, British, Japanese, Korean, Indian, Chinese, Australian and VA/DoD terms; records were confirmed by ESummary/EFetch. Official pages for NICE, VA/DoD, APA, BAP, RANZCP, CANMAT, JSMD and AWMF were fetched or web-retrieved live on 2026-08-30. The Indian 2025 adult update was found in the re-search and verified as PMID 41694044 by live ESearch and EFetch.
A 2026-08-31 re-check of NICE CG185, VA/DoD 2023, BAP, RANZCP, JSMD, CANMAT and AWMF BipolarLiving pages found no completed replacement documents. The sole PubMed title-term guideline hit with a print date after 2026-08-28 was an MDD anhedonia consensus (PMID 42314447), indexed June 2026 and not a bipolar practice guideline. APA psychiatryonline.org returned HTTP 403.
On 2026-09-03, five targeted live PubMed E-utilities searches re-examined CANMAT, NICE, VA/DoD, BAP and ACOG positions. The mixed-presentations CANMAT/ISBD supplement (PMID 34599629), NICE methods critique (PMID 26853311), historical BAP grading document (PMID 19329543), ACOG screening/diagnosis guideline (PMID 37486660) and historical CANMAT 2007 update (PMID 17156158) were added to make grading systems, phenotype-dependent ranks and supersession explicit. This pass did not claim that historical documents are current.
On 2026-10-09 (periodic sweep), NICE CG185 was re-fetched and still reports publication on 24 September 2014 and last update on 02 September 2025. The AWMF BipolarLiving page still lists version 2.1 as a registration ("Anmeldung"), and the CANMAT homepage returned HTTP 200 with no new bipolar guideline identified. PubMed searches covered bipolar/mania records with guideline, consensus, recommendation or position-statement title terms entered between 2026-08-28 and 2026-10-09 (2 hits: the JSMD correction and an ISBD/ECNP YMRS methodology consensus, the latter screened as trial methodology and not catalogued), the 2026 publication-year title search described in watch-list item 15, and a Korean Medication Algorithm Project search for 2026 (0 hits). APA psychiatryonline.org was not re-tried. Each new entry was checked against PubMed publication types and Crossref updated-by; none is retracted, and the two corrections are recorded above.
On 2026-10-23, NICE, CANMAT bipolar resources, the ISBD “CANMAT Guidelines…2025 Update” symposium listing, AWMF BipolarLiving, RANZCP and VA/DoD were fetched again. NICE still reports last update 02 September 2025 (published 24 September 2014). AWMF remains Anmeldung version 2.1; the Stellungnahme dated 22 October 2026 on that page is a statement on a Medizinischer Dienst Bund quality-criteria directive, not a bipolar guideline. RANZCP still marks the mood-disorders CPG as more than five years old and no longer current (last updated February 2020). VA/DoD still displays the 2023 guideline. The ISBD symposium page remains a members listing and was not treated as a replacement guideline. Topic-specific Cochrane reviews in the sweep window did not supersede a recommendation in this registry. The three ISBD rows added above were resolved by live ESummary, checked for retraction publication types (none) and checked in Crossref updated-by (empty). NExT and the lithium review were read in PMC full text. The vascular report was read from its abstract only.
On 2026-10-16, the windowed PubMed sweep and a targeted Polish Psychiatric Association search identified the two-part metabolic-risk update above. Part I’s publisher-hosted full text was retrieved; Part II’s scope was verified from its live PubMed record. Neither record has a PubMed retraction/concern publication type or Crossref updated-by entry. This is one paired guideline entry, not two independent guidelines. NICE still reports 2 September 2025; AWMF still lists an update registration; the retrieved RANZCP page continues to mark the mood-disorders CPG as no longer current; VA/DoD still displays the 2023 CPG. CANMAT’s bipolar resource page still links its 2018 guideline. ISBD also lists a members-only symposium titled “CANMAT Guidelines for Management of Patients with Bipolar Disorders – 2025 Update” (page dated 14 May 2026); the visible page does not supply a replacement guideline, so its title alone does not establish supersession. Sources: CANMAT resources, ISBD symposium listing, NICE, AWMF, RANZCP, VA/DoD, all accessed 2026-10-16. The TRBD correction is now listed by Europe PMC as free in PMC, but its XML endpoint failed and its HTML returned 403; the JSMD correction remains inaccessible. Their substantive effects remain unverified.