Pharmacotherapy of bipolar disorder (BD) is crucial to alleviate symptoms of acute mania, depression, mixed states or prevent recidivism. Symptomatology over the course of the disease can manifest in different ways. Adherence of patients with BD is complex, and psychiatric comorbidities play an important role.

National and international guidelines on treatment modalities of BD have been developed in recent years. This paper recapitulates similarities and discrepancies of international and national treatment guidelines of BD, and it puts the meaningfulness of those guidelines in the clinical context.

Comprehensive literature review on treatment guidelines of BD and compilation of recently held symposia during EPA congresses.

Pharmacotherapy of BD is challenging, not only due to the potentially severe course of the disorder, but also due to extremely long duration of untreated BD of over 10 years and a complex and alternating clinical picture. Treatment guidelines mostly suggest first-, second-, third-and fourth-line recommendations for acute mania, bipolar depression, mixed states and maintenance treatment. Least surprisingly, there are obvious differences between guidelines, especially when weighing efficacy and tolerability of mono- and combination therapies. This appears especially relevant for first-line recommendations.

This review discusses important national and international treatment guidelines, and puts those recommendations in a clinical framework using state-of-the-art literature of bipolar disorder.