pISSN 1226-6051
eISSN 2508-786X
eISSN 2508-786X
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.