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Table. 4.

Table. 4.

Treatment for mixed features across practice guidelines

Guidelines First-line treatment Next-step intervention Later intervention
KMAP-BP 2022 · Mixed mania: MS + AAP, Val, Li, ARI, OLA, QUE, RIS
· Mixed depression: MS + AAP, LMT + AAP, LMT + MS, Li, Val, LMT, ARI, OLA, QUE
· Mixed features without predominance: MS + AAP, Li, Val, LMT, ARI, OLA, QUE
· Mixed mania: 2MSs, AAP + LMT, LMT, MS + LMT, TAP, CBZ, ZIP 2MSs + AAP, MS + 2AAPs, MS + LMT + AAP, 2AAPs
· Mixed depression: 2MSs, 2MSs + AAP, MS + 2AAPs, MS + LMT + AAP, 2AAPs, MS + AD, AAP + AD, TAP
· Mixed features without predominance: MS + LMT, 2MSs, AAP + LMT, LMT, TAP
· Mixed mania: adding AD
· Mixed depression: Switching AD
· Mixed features without predominance: MS + AD, AAP + AD
BAP 2016 Same as for mania Same as for mania Same as for mania
CANMAT 2021 · Mixed mania: None determined
· Mixed depression: None determined
· Mixed features without predominance: ASP, ARI
· Mixed mania: ASP, CAR, Val, ARI
· Mixed depression: CAR, LUR
· Mixed features without predominance: OLA + MS, CBZ, OLA, Val
· Mixed mania: ZIP, OLA, OLA + MS, QUE, CBZ, ECT
· Mixed depression: OLA, OFC, QUE, Val, LMT, ZIP, ECT
· Mixed features without predominance: ZIP, Val + CBZ, CAR, Li + Val, ECT
CINP-BD-2017 OLA + Val (or Li) OLA, ARI, CBZ Val OFC, ZIP
NICE 2014 Same as for mania Same as for mania Same as for mania
RANZCP 2020 Li, Val, QUE · Mixed mania: adding ARI or ASP
· Mixed depression: adding LUR
· Mixed features without predominance: CAR, ZIP
· Mixed mania: MS + OLA
· Mixed depression: OLA, OFC
· Mixed features without predominance: CBZ, ECT

AAP, atypical antipsychotics; AD, antidepressant; ARI, aripiprazole; ASP, asenapine; BAP 2016, The British Association for Psychopharmacology Guidelines for Treatment for Bipolar Disorder 2016; CANMAT 2021, Canadian Network for Mood and Anxiety Treatments recommendations for the management of patients with bipolar disorder with mixed presentations; CAR, cariprazine; CBZ, carbamazepine; CINP-BD 2017, The International College of Neuropsychopharmacology Treatment Guidelines for Bipolar Disorder; ECT, electroconvulsive therapy; KMAP-BP 2022, Korean Medication Algorithms for Bipolar Disorder 2022; Li, lithium; LMT, lamotrigine; LUR, lurasidone; MS, mood stabilizer; NICE 2014, National Institute for Health and Clinical Excellence Treatment for Bipolar Disorder; OFC, olanzapine fluoxetine complex; OLA, olanzapine; QUE, quetiapine; RANZCP 2020, The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders; RIS, risperidone; TAP, typical antipsychotics; Val, various kinds of valproic acids; ZIP, ziprasidone.

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