Table.
Guideline Recommendations for the First-Line Treatment of Bipolar Disorder
| Guideline | Acute treatment | Maintenance | |||||
|---|---|---|---|---|---|---|---|
| Mania | Bipolar depression | Mixed states | Mania | Depression | |||
| VAD/DoD (2010)54 | Lithium, valproate, carbamazepine, aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone | Quetiapine, lamotrigine, lithium | Valproate, carbamazepine, olanzapine, aripiprazole, risperidone, ziprasidone | Agent effective in acute phase; monotherapy advised Lithium, olanzapine; lithium/valproate + quetiapine |
Agent effective in acute phase; monotherapy advised Lithium, lamotrigine; lithium/valproate + quetiapine |
||
| WFSBP (2009, 2010, 2013)55–57 | Aripiprazole, risperidone, valproate, ziprasidone | Bipolar I depression | Bipolar II depression | No specific recommendations | Mania | Depression | Any episode |
| Quetiapine | Quetiapine, lithium/valproate + pramipexole, valproate, antidepressants | Aripiprazole, lithium, quetiapine | Lamotrigine, quetiapine | Aripiprazole, lamotrigine, lithium, quetiapine | |||
| CANMAT (2013)38 | Lithium, valproate, aripiprazole, olanzapine, quetiapine, quetiapine XR, risperidone, ziprasidone, asenapine, paliperidone XR, lithium/valproate + aripiprazole, lithium/valproate + olanzapine, lithium/valproate + quetiapine, lithium/valproate + risperidone, lithium/valproate + asenapine | Bipolar I depression | Bipolar II depression | No specific recommendations | Bipolar I disorder | Bipolar II disorder | |
| Lithium, lamotrigine, quetiapine, quetiapine XR, lithium/valproate + SSRI, olanzapine + SSRI, lithium + valproate, lithium/valproate + bupropion | Quetiapine, quetiapine XR | Lithium, lamotrigine (limited efficacy in preventing mania), quetiapine, risperidone LAI, aripiprazole, lithium/valproate + quetiapine, lithium/valproate + risperidone, LAI lithium/valproate + aripiprazole or lithium/valproate + ziprasidone | Lithium, lamotrigine, quetiapine | ||||
| BAP (2009)52 | Mild: lithium, carbamazepine Severe: antipsychotic, valproate |
Bipolar depression | Mild: lithium, carbamazepine Severe: antipsychotic, valproate | Mania | Depression | ||
| Quetiapine, lamotrigine, SSRI or other antidepressant (not TCA) | Lithium, aripiprazole, quetiapine, valproate, olanzapine | Quetiapine, lamotrigine | |||||
| APA (2002)21 | Severely ill: lithium/valproate + antipsychotic Less severely ill: lithium, valproate, antipsychotic | Severely ill: lithium/valproate + antipsychotic Less severely ill: lithium, valproate, antipsychotic | Lithium, lamotrigine | Severely ill: lithium/valproate + antipsychotic Less severely ill: lithium, valproate, antipsychotic | Lithium, valproate, carbamazepine, oxcarbazepine | ||
LAI indicates long-acting injection; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant; XR, extended release.