Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.
Clinician reference tool — not a prescriber, not a diagnosis, not medical advice. Deterministic, phase-gated suggestions to think with, grounded in the CANMAT/ISBD, NICE and RANZCP bipolar guidelines. Bipolar disorder is high-stakes (suicide and mania-switch risk) — psychiatric assessment, current product monographs and the treating clinician’s judgement are always required. Runs entirely in your browser — no data is collected.

Evidence: Yatham LN 2023 · sources last checked 2026-07-22

Bipolar disorder treatment selector

Choose the current illness phase — acute mania, acute bipolar depression, or maintenance — and the phase selects the first-line option set, exactly as the guidelines do. Add the bipolar type and any safety flags to get ranked, reasoned suggestions across the Health Canada-approved formulary, with the guideline reasoning and references behind each.

Guideline lens

Current phase *required — this gates the options

The phase determines which agents are first-line — e.g. lamotrigine is first-line for bipolar depression but ineffective for mania; antidepressants are stopped in mania.

Clinical profile

Bipolar type

Prior response (optional)

Safety & course flags

Childbearing potential routes out valproate & carbamazepine; suicidality foregrounds crisis resources and favours lithium; mixed features / rapid cycling caution antidepressants.

Safety & guideline notes

  • • Per CANMAT/ISBD (2018; 2023 update): treatment is phase-gated. Acute mania — first-line lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone or cariprazine (or an atypical + lithium/divalproex); antidepressants are stopped; lamotrigine is ineffective. Acute bipolar depression — first-line quetiapine, lithium, lamotrigine or lurasidone (± lithium/divalproex); antidepressants only ever adjunctive. Maintenance — first-line lithium, quetiapine, divalproex, lamotrigine, asenapine or aripiprazole, weighing mania- vs depression-pole prophylaxis.
  • • Lithium requires baseline and ongoing monitoring: serum level (narrow therapeutic index — toxicity), renal function, thyroid and calcium; counsel on hydration, drug interactions (NSAIDs, ACE inhibitors, diuretics) and toxicity signs.
  • • This tool assumes a confirmed diagnosis of bipolar disorder and does not diagnose, prescribe, or set doses. Bipolar disorder is high-stakes (suicide and mania-switch risk); psychiatric assessment, the live Health Canada product monographs, and the treating clinician's judgement are always required.

Select the current phase to begin.

Acute mania, Acute bipolar depression, or Maintenance — the phase gates which agents are first-line.

References

  1. [1]Yatham LN, et al. CANMAT and ISBD 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018;20:97–170. link
  2. [2]Yatham LN, et al. The CANMAT and ISBD Guidelines for the Treatment of Bipolar Disorder: Summary and a 2023 Update of Evidence. Focus (Am Psychiatr Publ) 2023;21:e20230009. link
  3. [3]NICE CG185 — Bipolar disorder: assessment and management (National Institute for Health and Care Excellence). link
  4. [4]Malhi GS, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (RANZCP). Aust N Z J Psychiatry 2021;55:7–117. link
  5. [5]Health Canada — Drug Product Database & product monographs (lithium/Carbolith/Lithane, divalproex/Epival, lamotrigine/Lamictal, carbamazepine/Tegretol, quetiapine/Seroquel, olanzapine/Zyprexa, risperidone/Risperdal, aripiprazole/Abilify & Maintena, asenapine/Saphris, paliperidone/Invega, cariprazine/Vraylar, lurasidone/Latuda, ziprasidone/Zeldox). link
  6. [6]Pacchiarotti I, et al. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry 2013;170:1249–1262. link
  7. [7]Cipriani A, et al. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ 2013;346:f3646. link
  8. [8]Health Canada — Valproate: risk of serious harm to the fetus (teratogenicity and neurodevelopmental effects); pregnancy-prevention considerations. Also applies (teratogenicity) to carbamazepine. link
  9. [9]Health Canada approves VRAYLAR (cariprazine) for the treatment of bipolar I disorder and schizophrenia in adults (27 April 2022). link