Table 3.
Summary of treatment guidelines for mood episodes in bipolar disorder
| EPISODE | APA | CONSENSUS GUIDELINE | CANMAT | OTHER EVIDENCE |
|---|---|---|---|---|
| Mania—euphoric | Lithium | Traditional (non-AAP) MS: lithium or valproate | N/A | Lithium |
| Mania—mild or moderate | Lithium or valproate | Traditional (non-AAP) MS: lithium or valproate | N/A | Valproate and/or AAP(1) |
| Mania—severe | Valproate or lithium with AAP | Valproate and AAP | N/A | Valproate and/or AAP(1) |
| Mania—mixed | Valproate | Traditional and AAP | N/A | Valproate or AAP |
| Rapid cycling—depression | MS(1) and MS(2) | Lamotrigine or lamotrigine/ lithium | Lithium Lamotrigine Valproate | Lamotrigine |
| Rapid cycling—mania | MS(1) and MS(2) | Valproate or valproate/AAP | Lithium Lamotrigine Valproate | Valproate |
| Depression—mild or moderate(2) | Optimize MS | N/A | N/A | N/A |
| Depression—severe | MS(1) and SSRI, MS(2), or ECT | N/A | N/A | N/A |
Key:
- APA—
American Psychiatric Association. In: Hirschfeld RMA, Bowden CL, Gitlin MJ, et al. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry 2002;159(Suppl):1–35.
- Consensus Guideline—
Keck P, Perlis R, Otto M, et al. The Expert Consensus Guideline Series: Medication treatment of bipolar disorder 2004. Postgrad Med 2004;1–120.
- CANMAT—
Canadian Network for Mood and Anxiety Treatments
- AAP—
atypical antipsychotic
- MS—
mood stabilizer
- ECT—
electroconvulsive therapy
- 1—
Particularly if insomnia significant
- 2—
If no mood stabilizer, initiate one
- N/A—
Not addressed