Table 3.
Treatment of bipolar depression across practice guidelines
| Guidelines | First-line treatment | Next-step intervention | Later intervention |
|---|---|---|---|
| KMAP-BP 201816) | Mild to moderate: Li, Val, LTG, ARP, QTP, MS+(ARP or OLZ or QTP) Non-psychotic severe: Li, Val, LTG, ARP, QTP, MS+(ARP or OLZ or QTP) Psychotic: Li, Val, LTG, QTP, OLZ, ARP, MS+(QTP or OLZ or ARP) |
Mild to moderate: Add LTG or AAP or MS Non-psychotic severe: Add MS or AAP or LTG or AD, Change MS or AAP, ECT Psychotic: Add MS or AAP or LTG or AD, Change MS or AAP |
Add (or change to) CLZ, Add buspirone or stimulant or thyroid hormone, ECT, rTMS |
| BAP 201617) | Without AM: QTP, OFC, lurasidone, LTG combination, AD combination With AM; optimization, QTP, OFC, lurasidone, LTG, AD Consider ECT in severe depression |
Add anti-manic agent, ECT | |
| CANMAT 201818) | QTP, lurasidone+Li (or Val), LTG, lurasidone, LTG (adj) | Val, SSRI/BUP (adj), ECT, cariprazine, OFC | CBZ, Adj: OLZ, SNRI/MAOI, modafinil, eicosapentaenoic acid, rTMS, ketamine, light therapy/sleep deprivation, Levothyroxine, N-acetylcysteine, pramipexle, ARP, armodafinil, ASP |
| CINP-BD-201719) | QTP, lurasidne, OFC | Val, Li, MS+lurasidone (or modafinil or pramipexole) Li+pioglitazone, Add escitalopram or FX | ARP, imipramine, phenezine, Li+OXC (or L-sulpiride) |
| NICE 201423) | Without AM; OLZ+FX, QTP, OLZ, LTG With AM; optimization, adjunctive OLZ+FX, adjunctive QTP, OLZ (adj), LTG (adj) |
Adding LTG | |
| WFSBP 201025) | QTP, QTP (adj), OFC, OLZ, LTG, LTG+Li, Val | Optimization of first-line treatment, QTP add CBZ, Li, MDF+Li/Val/ADs, ECT |
KMAP-BP, Korean Medication Algorithms for Bipolar Disorder; BAP, The British Association for Psychopharmacology Guidelines for Treatment for Bipolar Disorder; CANMAT, Canadian Network for Mood and Anxiety Treatments; CINP-BD, International College of Neuro-Psychopharmacology Treatment Guidelines for Bipolar Disorder; NICE, National Institute for Health and Clinical Excellence Treatment for Bipolar Disorder; WFSBP, World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Bipolar Disorder on the treatment of acute bipolar depression; Li, lithium; Val, various kinds of valproic acid; LTG, lamotrigine, ARP, aripiprazole; QTP, quetiapine; MS, mood stabilizer; OLZ, olanzapine; AAP, atypical antipsychotic; AD, antidepressant; ECT, electroconvulsive therapy; CLZ, clozapine; rTMS, repetitive transcranial magnetic stimulation; AM, antimanic agents; OFC, olanzapine-fluoxetine complex; SSRI, selective serotonin reuptake inhibitor; BUP, bupropion; adj, adjunctive; CBZ, carbamazepine; SNRI, serotonin norepinephrine reuptake inhibitor; MAOI, monoamine oxidase inhibitor; ASP, asenapine; FX, fluoxetine; OXC, oxcarbazepine; MDF, modafinil.