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Table. 3.

Table. 3.

Treatment of bipolar depression across practice guidelines

Guidelines First-line treatment Next-step intervention Later intervention
KMAP-BP 2022 · Mild to moderate: Li, Val, LMT, ARI, QUE, OLA, MS + AAP (ARI/QUE/OLA) LMT + AAP (ARI/QUE/OLA)
· Non-psychotic severe: MS + AAP (ARI/QUE/OLA), AAP + LMT, MS + LMT
· Psychotic: MS + AAP (ARI/QUE/OLA/RIS) LMT + AAP
· Mild to moderate: adding or change AAP/LMT/MS, MS + LMT, 2AAPs
· Non-psychotic severe: Change MS or AAP, MS + LMT + AAP, MS + 2AAPs, 2MSs + AAP, LMT + 2AAPs, MS + AD, AAP + AD
· Psychotic: Change MS or AAP, MS + LMT, MS + LMT + AAP, MS + 2AAPs, 2MSs + AAP, LMT + 2AAPs, AAP + AD, MS + AD
Add (or change to) CLZ, Add buspirone or stimulant or thyroid hormone, ECT, rTMS
BAP 2016 · Without AM: QUE, OLA, LMT, LUR, LMT combination
· With AM: optimization, QUE, OLA, LUR, LMT Consider ECT in severe depression
AD combination, ECT
CANMAT 2018 QUE, LUR + Li (or Val), LMT, LMT (adj) Val, SSRI/bupropion (adj), ECT, CAR, OFC · CBZ
· Adj: OLA, SNRI/MAOI, modafinil, eicosapentaenoic acid, rTMS, ketamine, light therapy/sleep deprivation, Levothyroxine, N-acetylcysteine, pramipexle, ARI, armodafinil, ASP
CINP-BD-2017 QUE, LUR, OFC Val, Li, MS + (or modafinil or pramipexole), Li + pioglitazone, Add escitalopram or FX ARI, imipramine, phenezine, Li + OXC (or L-sulpiride)
NICE 2014 · Without AM: OFC, QUE, OLA, LMT
· With AM: optimization, OFC (adj), QUE (adj), OLA (adj), LMT (adj)
Adding LMT
RANZCP 2020 Li, LMT, Val, QUE, LUR, CAR MS + AAP, 2MSs, MS + AD, AAP + AD, 2MSs + AAP, 2MSs + AD, MS + AAP + AD, 2MSs + AAPs + AD, ECT CBZ, OLA, ASP (adj), Armodafinil (adj), Levothyroxine (adj)

AAP, atypical antipsychotic; AD, antidepressant; AM, antimanic agents; ARI, aripiprazole; ASP, asenapine; BAP 2016, The British Association for Psychopharmacology Guidelines for Treatment for Bipolar Disorder 2016; CANMAT 2018, Canadian Network for Mood and Anxiety Treatments 2018; CAR, cariprazine; CBZ, carbamazepine; CINP-BD 2017, The International College of Neuropsychopharmacology Treatment Guidelines for Bipolar Disorder 2017; CLZ, clozapine; ECT, electroconvulsive therapy; FX, fluoxetine; KMAP-BP 2022, Korean Medication Algorithms for Bipolar Disorder 2022; Li, lithium; LMT, lamotrigine; LUR, lurasidone; MAOI, monoamine oxidase inhibitor; MS, mood stabilizer; NICE 2014, National Institute for Health and Clinical Excellence Treatment for Bipolar Disorder 2014; OFC, olanzapine-fluoxetine complex; OLA, olanzapine; OXC, oxcarbazepine; QUE, quetiapine; RANZCP 2020, The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders; Val, various kinds of valproic acid; RIS, risperidone; rTMS, repetitive transcranial magnetic stimulation; adj, adjunctive; SNRI, serotonin norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor.

Korean J Clin Pharm 2023;33:153-67 https://doi.org/10.24304/kjcp.2023.33.3.153
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