Implementing evidence-based treatment of manic and mixed episodes.

Manic and mixed episodes can be challenging to treat despite published guidelines and algorithms. An alternative iterative approach that offers evidence-based treatment options at critical decision points may help to individualize care. Implementing such an approach begins with making a diagnosis and recognizing individual patient factors, weighing treatment options, and developing a menu of reasonable treatment choices based on the best available evidence. A critical review of the evidence is needed to ensure that interventions with the highest quality evidence are offered preferentially and that relevant individual factors are considered. Educating patients, negotiating treatment options, and selecting a pathway of care with the patient are important steps before initiating an intervention. After initiating an intervention, follow-up proceeds by measuring efficacy and adverse events with the aim of determining whether or not the patient is benefiting from treatment. Based on this knowledge, new individual factors are known and new evidence can be reviewed, so the cycle begins again. Using this iterative approach to treat patients with bipolar disorder in manic and mixed episodes promotes personalized care and relies on understanding the quality of evidence for the treatments commonly used to treat these phases of bipolar disorder.