Bipolar disorder is a severe brain disorder that causes abnormal strong shifts in mood, activity levels and energy, and causes severe stress to patients and their caregivers. The life expectancy of patients with bipolar disorder is reduced by about 10 years, likely due to medical comorbidity, high suicide rates and adverse lifestyles. The burden of the disorder constitutes a major health economic challenge for societies: according to the most recent WHO global burden of disease study, bipolar disorders rank within the top 20 causes of disability among all medical conditions worldwide, and rank 6th among the mental disorders.

World Bipolar Day is a global initiative founded by various professional societies and foundations to bring world awareness to bipolar disorders and to eliminate social stigma. Through international collaboration, the goal of World Bipolar Day is to bring the world population information about bipolar disorders that will educate and improve sensitivity towards the illness. World Bipolar Day occurs each year on March 30th, the birthday of Vincent van Gogh, who was posthumously diagnosed as probably having bipolar disorder.

IJBD has launched a series of publications aiming to present areas of controversy and uncertainty in bipolar disorder

International Journal of Bipolar Disorders (IJBD) is again proud to support World Bipolar Day in 2019, six years after the journal’s launch as the first open access online journal dedicated to publication and communication on all aspects of bipolar disorder.

While pharmacotherapy and other biological treatment options have formed the foundation for successful treatment of bipolar disorder for more than seven decades, several therapeutic interventions are still controversial, and sometimes their application may differ across continents, countries or clinical settings quite significantly. Recently, IJBD has launched a series of publications aiming to present areas of controversy and uncertainty in bipolar disorder, and seeking to identify reasons for some of the dilemmas and future solutions to it. Experts with international recognition have been invited to contribute to this collection of articles.

Two discussions of these controversies have been published so far. In the first article in this new series, Michael Gitlin examines the ongoing disagreements on the subject of using antidepressants for bipolar disorder. He highlights the striking incongruity between the wide clinical administration of antidepressant drugs for bipolar disorder despite the weak evidence base for their efficacy.

In the second article, Sameer Jauhar and Allan Young discuss disagreements around using second generation antipsychotics (SGA) for the maintenance treatment of bipolar disorder. SGA are also called atypical antipsychotics and are typically used for psychotic disorders. Their use for the acute treatment of manic episodes is well established, but they are also used for maintenance treatment in bipolar disorder, as monotherapy or adjunctive therapy, or to treat acute depressive episodes.

This is less supported by evidence, and more controversial due to side effects and limited long-term efficacy data. This is particularly the case for prevention of depressive episodes, where they appear to be less effective. The authors conclude that for people who are intolerant or unable to adhere to lithium, the classic “gold standard” medication, maintenance treatment with antipsychotics seems reasonable, but this requires individualized care to manage side effects.

We look forward to publishing more in this series, and to supporting the goals of World Bipolar Day throughout the year.