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International guidelines providing recommendations for the long\u2010term treatment of BD\u2010I were included. A methodological quality assessment was conducted with the Appraisal of Guidelines for Research and Evaluation\u2010AGREE II.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The final selection yielded five international guidelines, with overall good quality. The evaluation of applicability was the weakest aspect across the guidelines. Differences in their updating strategies and the rating of the evidence, particularly for meta\u2010analyses, randomized clinical trials (RCTs) and observational studies, could be responsible of some level of heterogeneity among recommendations. Nonetheless, the guidelines recommended lithium as the \u2018gold standard\u2019 in the long\u2010term treatment of BD\u2010I. Quetiapine was another possible first\u2010line option as well as aripiprazole (for the prevention of mania). Long\u2010term treatment should contemplate monotherapy, at least initially. Clinicians should check regularly for efficacy and side effects and if necessary, switch to first\u2010line alternatives (i.e. Valproate), combine first\u2010line compounds with different mechanisms of action or switch to second\u2010line options or combinations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The possibility to monitor improvements in long\u2010term outcomes, namely relapse prevention and inter\u2010episode subthreshold depressive symptoms, based on the application of their recommendations is an unmet need of clinical guidelines. In terms of evidence of clinical guidelines, there is a need for more efficacious treatment strategies for the prevention of bipolar depression.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.13040","type":"journal-article","created":{"date-parts":[[2020,12,24]],"date-time":"2020-12-24T11:45:26Z","timestamp":1608810326000},"page":"324-340","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Long\u2010term treatment of bipolar disorder type I: A systematic and critical review of clinical guidelines with derived practice algorithms"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9488-2881","authenticated-orcid":false,"given":"Norma","family":"Verdolini","sequence":"first","affiliation":[{"name":"Bipolar and Depressive Disorders Unit Hospital Clinic, University of Barcelona, Institute of Neuroscience IDIBAPS CIBERSAM Barcelona Catalonia 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