Applying Evidence-Based Principles to the Treatment of Bipolar Disorder

In the more than quarter-century since Guyatt (1) coined the term evidence-based medicine, the concept has evolved to describe medical treatments that not only strive to merge high-quality research findings with practitioners’ own observations but also reflect awareness of the best available evidence, define the trustworthiness of that evidence, and incorporate patient values and preferences for deciding among treatment risks, benefits, and costs (2). In the world of bipolar disorder, there is a tendency for practice guidelines, review papers, and educators to identify evidence-based treatments along the lines of specific illness phases or within other narrow contexts—treatment of bipolar depression, maintenance pharmacotherapy, rapid cycling, bipolar II disorder, or adjunctive psychotherapy—to prevent relapse or improve quality of life. Long missing from the literature has been a “big picture” approach to evidence-based practices in treating bipolar disorder, in which patient presentations are considered not in such a piecemeal fashion, but rather, in light of their frequently atypical, comorbidly ill, multicombination therapy, treatment-resistant and psychosocially complicated contexts.

The theme of this issue of Focus is applying evidence-based principles to the treatment of bipolar disorder. Our goal in developing this issue was to present a coherent and contemporary summary for practitioners of state-of-the-art treatments that reflects best practices and credible empirical observations from randomized trials. It is the pragmatic translation of those data into clinical situations that we sought most to capture. We have tried to structure the contributions in this issue to address key topics that clinicians may not readily find addressed elsewhere—among them, how to apply randomized controlled trial data to individual patients, knowing “rules of the road” for constructing (or deconstructing) complex combination medication regimens, gaining familiarity with the evidence base for ketamine and other novel emerging pharmacotherapies, comprehending the tenets of evidence-based psychotherapy for bipolar disorder, and understanding how to gauge risks and benefits of pharmacotherapy during pregnancy and lactation.

I am most grateful to the experts who contributed their time and energy to produce this ensemble of articles. As guest editor, I very much appreciate the opportunity to present this issue as a collective resource to our readers. I hope your will find its contents accessible and valuable for both the scientific and practical insights of our authors.