While pharmacotherapy and other biological treatment options form the foundation for successful treatment of bipolar disorder for more than seven decades, several therapeutic interventions are still controversial and sometimes its applications may differ across continents, countries or clinical settings quite significantly. This collection of articles aims to present four areas of controversy and uncertainty in bipolar disorder seeking to identify reasons for some of the dilemmas and future solutions to it. The risk-benefit profile of antidepressant medications for the treatment of bipolar depression and of atypical antipsychotics for maintenance treatment are such areas of controversial opinions among academic experts and clinicians. One of the reasons for the controversies for example is the striking incongruity between the wide use of and the weak evidence base for the efficacy of antidepressant drugs in bipolar disorder. The lack of sufficient long-term safety data for atypical antipsychotics raises concerns about its proper role in the maintenance treatment. While having many treatment options it remains also unclear to a large extend why bipolar disorder is associated with increased mortality rates that cannot be explained alone by the high suicide rates associated with this disorder.
The topics for this collection of articles have been identified among members of the editorial board of International Journal of Bipolar Disorders. Subsequently, experts with international recognition have been invited to contribute to this collection of articles. The articles have undergone the journal's standard peer-review process overseen by the Editor-in-Chief and Associate Editors.