Table 6.
Continuation and maintenance treatment across practice guidelines
| Guidelines | First-line treatment | Next-step intervention | Later intervention |
|---|---|---|---|
| KMAP-BP 201412 | BP-I, recently manic: MS + AAP, MS, AAP | BP-I, recently manic: MS + LTG, two MSs | Recently manic and hypomanic: AAP + LTG, MS + AAP + LTG, AAP + MS + AD, LTG |
| BP-I in breakthrough mania: optimization, MS + AAP, add AAP | BP-I in breakthrough mania: Li or Val + other MS, change MS | BP-I in breakthrough mania: optimize/change MS | |
| BP-II, recently hypomanic: MS, AAP, MS + AAP | BP-I, recently depressed: two MSs, MS + AAP + LTG | BP-I, recently depressed: AAP + AD, MS + AAP + AD, MS + AD | |
| BP-I and BP-II, recently depressed: AAP or MS + LTG, MS + AAP, MS, AAP, LTG | BP-II, recently hypomanic: AAP + LTG, MS + LTG | BP-II, recently depressed: MS + AAP + AD, AAP + AD + LTG | |
| BP-II, recently depressed: AAP + MS + LTG, MS + AD | |||
| BAP 200913 | If mania predominates: Li, ARP, QTP, Val, OLZ | If mania predominates: CBZ | Combination therapy: CLZ |
| If depression predominates: QTP, LTG | If depression predominates: Li | ||
| CANMAT 201314 | Li, LTG (limited efficacy in preventing mania), Val, OLZ, QTP, RIS LAI, ARP, adjunctive with MS: QTP, RIS LAI, ARP, ZIP | CBZ, PAL, Li + Val, Li + CBZ, Li or Val + OLZ, Li + RIS, Li + LTG, OLZ + FX | ASA |
| Adjunctive phenytoin, adjunctive CLZ, adjunctive ECT, adjunctive TP, adjunctive omega-3-fatty acid, adjunctive OXC, or adjunctive gabapentin Adjunctive ASA |
|||
| NICE 201415 | Li | Val, OLZ, QTP | |
| WFSBP 201318 | ARP (mania and any episode), LTG (depression and any episode), Li (any episode), QTP (any episode) | OLZ (mania and any episode), RIS (mania and any episode) | AD (depression), PAL (mania and any episode), Val (depression), adjunctive ZIP (mania and any episode) |
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 2013, World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Bipolar Disorder 2013 (maintenance treatment); BP-I, bipolar I disorder; MS, mood stabilizer; AAP, atypical antipsychotic; BP-II, bipolar II disorder; LTG, lamotrigine; Li, lithium; Val, various kinds of valproic acids; AD, antidepressant; ARP, aripiprazole; QTP, quetiapine; OLZ, olanzapine; CBZ, carbamazepine; CLZ, clozapine; RIS LAI, risperidone long-acting injection; ZIP, ziprasidone; PAL, paliperidone; RIS, risperidone; FX, fluoxetine; ASA, asenapine; ECT, electroconvulsive therapy; TP, topiramate; OXC, oxcarbazepine.