Clinical practice guidelines for the management of bipolar disorder: 2025 update

The Indian Psychiatric Society has previously published guidelines for the management of bipolar disorder (BD) in adults (2017) and children and adolescents (2019). The present guideline summarizes the major advancements in the management of BD since these publications. To make the guideline handier for the clinical practitioner, we have made several structural changes compared to the 2017 guideline. First: we have adopted a phase-specific approach with different sections and management algorithms for each major phase of BD (mania, depression, and mixed episodes in bipolar type I disorder [BD-I] and depression in bipolar type II disorder [BD-II]). Second: for better clarity and ease of adoption, we have structured our suggestions into first, second, and third-line treatments; these rankings are based on the composite of evidence, experience, and consensus ratings of efficacy, tolerability, availability, and affordability. Third: a separate section for BD-II disorder has been added, given its relatively high prevalence in the Indian setting. Fourth: we have added a detailed section on special treatment considerations, where practical issues such as the management of comorbidities, treatment adherence, the role of polypharmacy, clozapine, emerging treatments, and long-acting injectables, as well as the reproductive safety of medications in BD, are discussed. Finally, we have added an expert consensus section where we present our consensus opinions on common dilemmas in the management of BD. We liberally use tables and flowcharts to enhance understanding and uptake of the suggestions offered. We hope these guidelines promote evidence-informed decision-making in the management of BD.