SMF Schweizerisches Medizin-Forum 1424-4020 1424-3784 EMH Schweizerischer Ärzteverlag AG Farnsburgerstrasse 8 CH-4132 Muttenz 08325 10.4414/smf.2019.08325 Richtlinien Psychiatrie und Psychotherapie Bipolare Störungen: Update 2019 Hasler Gregor gregor.hasler@unifr.ch SWITZERLAND Preisig Martin University of Lausanne Müller Thomas J. Privatklinik Meiringen Kawohl Wolfram Psychiatrische Klink Königsfelden Aubry Jean-Michel University of Geneva Greil Waldemar Stauffacherpraxis, Zürich 14 08 2019 19 3334 537 546 Copyright: EMH Schweizerischer Ärzteverlag AG 2019 EMH Schweizerischer Ärzteverlag AG "Swiss Medical Forum" is an open access publication of EMH published in accordance with the terms of the Creative Commons licence attribution - NonCommercial - NoDerivatives 4.0 International. You are free to share, copy and redistribute the material in any medium or format under the following terms: Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. NonCommercial — You may not use the material for commercial purposes. NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material. "Non-commercial" means not primarily intended for or directed towards commercial advantage or monetary compensation. The incorporation of publications in commercial products, the use of publications to advertise for commercial products or services and any other usage that directly or indirectly pursues commercial interests is subject to the express previous consent of the publishing house as part of a written agreement. Please send us your request in writing. Exact indication of the publication from which you would like to reproduce material and detailed information about its intended use help to facilitate and expedite request processing. <p>This article summarizes the treatment recommendations for bipolar disorders developed by the Swiss Society of Bipolar Disorders. It is the second update of our recommendation published in 2011. They are based on evidence from randomized-controlled studies, international treatment guidelines and observational studies. Although the most solid evidence exists for pharmacotherapy, a bio-psycho-social treatment approach including psychoeducation and psychotherapy is required to achieve optimal treatment outcomes for patients with Bipolar Disorder. The recommendations are largely unchanged. Regarding psychosocial interventions, there is new evidence for efficacy of mindfulness-based cognitive therapy to reduce depressive and anxiety symptoms. For acute mania, lithium, valproate, several atypical antipsychotics and their combinations remain the first-line treatment options; cariprazine has been added to the list of recommended atypical antipsychotics. Quetiapine and lithium, lamotrigine and newly lurasidone are recommended for bipolar depression as well as combinations of mood stabilizing drugs with SSRI or bupropion. First-line options for maintenance treatment of Bipolar Disorder are lithium, quetiapine, lamotrigine (the latter predominately for prevention of depression), valproate, olanzapine, aripiprazole (the latter for prevention of mania only). Asenapine and aripirazole as long-acting injectable have been added as options in the maintenance treatment. The guidelines include recommendations regarding safety monitoring of pharmacological treatment.</p>