. 2015 Jun 26;11:1561–1571. doi: 10.2147/NDT.S86552

Table 2.

Treatment of acute euphoric/classic mania across practice guidelines

Guidelines	First-line treatment	Next-step intervention	Later intervention
KMAP-BP 2014¹²	Li, Val, Li or Val + AAP	Li or Val + AAP, Li or Val + two AAPs, Val + Li + AAP	Two AAPs + Li + Val, Li + Val + other AAP
BAP 2009¹³	Mild: AP or Val or Li (or CBZ)	Li or Val + AP	ECT or CLZ
BAP 2009¹³	Severe: AP or Val (if required IM: AP or BZ)	Li or Val + AP	ECT or CLZ
CANMAT 2013¹⁴	Li, Val, OLZ, RIS, QTP, QTPXR, ARP, ZIP, ASP, PAL	CBZ, ECT, HP, Li + Val	CPZ, CLZ, OXC, tamoxifen, cariprazine, Li or VAL + HP, Li + CBZ, adjunctive tamoxifen
CANMAT 2013¹⁴	Adjunctive with MS: RIS, QTP, OLZ, ARP, ASP	CBZ, ECT, HP, Li + Val
NICE 2014¹⁵	Without AM: HP, OLZ, QTP, OLZ	Alternative AP or adding Li or Val	ECT
NICE 2014¹⁵	With Li: optimization, adding HP, OLZ, QTP, RIS	Alternative AP or adding Li or Val	ECT
WFSBP 2009¹⁶	Monotherapy with CE 1 and RG A such as Val, ARP, ZIP, and RIS	Optimize dosage; switch to another first-line agent; in severe mania, consider combination	Add-on with first-line agent; combination of two first-line choices

Abbreviations: KMAP-BP 2014, Korean Medication Algorithm Project for Bipolar Disorder 2014; BAP 2009, The British Association for Psychopharmacology Guidelines for Treatment of Bipolar Disorder 2009; CANMAT 2013, Canadian Network for Mood and Anxiety Treatments Clinical Guidelines for the Management of Patients with Bipolar Disorder 2013; NICE 2014, National Institute for Health and Clinical Excellence Clinical Guideline for Bipolar Disorder 2014; WFSBP 2009, World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Bipolar Disorder 2009 (treatment of acute mania); Li, lithium; Val, various kinds of valproic acids; AAP, atypical antipsychotic; AP, antipsychotics; CBZ, carbamazepine; IM, intramuscular formulation; BZ, benzodiazepine; ECT, electroconvulsive therapy; CLZ, clozapine; OLZ, olanzapine; RIS, risperidone; QTP, quetiapine; QTPXR, quetiapine XR; ARP, aripiprazole; ZIP, ziprasidone; ASP, asenapine; PAL, paliperidone; HP, haloperidol; CPZ, chlorpromazine; OXC, oxcarbazepine; AM, antimanic agents; CE, categories of evidence; RG, recommendation of grade.