Table 18.
Level of Recommendation Concerning Monotherapy in Acute Bipolar Depression, in Comorbid Conditions and Rapid Cycling Patients, and Recommended Dosages for Medication Options
| Agent/modality | Overall | BD-I | BD-II | Depressive core | Comorbid anxiety | Rapid cycling | Recommended dosage (mg/d) |
|---|---|---|---|---|---|---|---|
| Quetiapine | 1 | 3 | 3 | 3 | 3 | 2 | 300–600 mg/d |
| Lurasidone | 1 | - | - | 3 | 3 | - | 20–120 mg/d |
| OFC | 2 | 2 | - | 3 | - | - | 6 + 25; 6 + 50; 12 + 50 mg/d |
| Escitalopram | - | - | 1 | - | - | - | 10 mg/d |
| Fluoxetine | 2 | - | 3 | - | - | - | 20–80 mg/d |
| Olanzapine | 2 | 4 | - | 3 | - | - | 5–20 mg/d |
| Carbamazepine | 3 | - | - | - | - | - | 300–800 mg/d |
| Valproate | 3 | 3 | 5 | 3 | 3 | 4 | 500–2500 mg/d (50–100 mcg/mL) |
| Aripiprazole | 3 | 3 | - | - | - | - | 5–30 mg/d |
| Imipramine | 3 | - | - | - | - | - | 75–300 mg/d |
| Lamotrigine | 3 | 3 | 3 | 3 | - | - | 50–200 mg/d |
| Phenelzine | 3 | - | - | - | - | - | 15–90 mg/d |
| Lithium | 4 | - | 4 | - | 5 | 3 | 600–1800 mg/d |
| Tranylcypromine | 4 | 4 | 4 | - | - | - | 20–30 mg/d |
| Venlafaxine | 4 | 4 | 4 | - | - | - | 75–225 mg/d |
| Paroxetine | 5 | 5 | 5 | - | 3 | 5 | 20 mg/d |
| Ziprasidone | 5 | 5 | - | - | 5 | - | |
| Gabapentin | 5 | - | - | - | - | - | |
| rTMS | 5 | - | - | - | - | - | |
| Risperidone | - | - | - | - | 5 | - |
Abbreviations: NR, not recommended; OFC, olanzapine-fluoxetine combination; rTMS, repetitive Transcranial Magnetic Stimulation.