Table 6.
Maintenance treatment across practice guidelines
| Guidelines | First-line treatment | Next-step intervention | Later intervention |
|---|---|---|---|
| KMAP-BP 201816) | Preventing manic: MS+AAP, MS, AAP Preventing depressive: MS+(AAP or LTG), MS, LTG, AAP, MS+AAP+LTG |
Preventing manic: MS+LTG, 2 MSs, AAP+LTG Preventing depressive: 2 MSs, MS+AAP+AD |
Preventing manic: MS+AAP+LTG, LTG Preventing depressive: AAP+AD, MS+AD |
| BAP 201617) | Li | If mania predominates; Val, OLZ, QTP, RIS LAI, CBZ, OXC If depression predominates; LTG, QTP, lurasidone |
Combination therapy, AD, CLZ, Maintenance ECT |
| CANMAT 201818) | Li, QTP, Val, LTG, ASP, QTP+Li (or Val), ARP+Li (or Val), ARP, ARP OM | OLZ, RIS LAI, RIS LAI (adj), CBZ, PAL, lurasidone+Li (or Val), ZIP+Li (or Val) | ARP+LTG, OFC, CLZ (adj), gabapentine (adj) |
| CINP-BD-201719) | Li, ARP, OLZ, PAL, QTP, RIS, RIS LAI | Add FX or Li, Li+CBZ, QTP+Li (or Val), MS+OLZ (or ARP) | Add RIS LAI or CBZ or LTG or N-acetylcysteine |
| NICE 201423) | Li | Val, OLZ, QTP | |
| WFSBP 201326) | 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) |
KMAP-BP, Korean Medication Algorithms for Bipolar Disorder; BAP, The British Association for Psychopharmacology Guidelines for Treatment for Bipolar Disorder; CANMAT 2018, 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: Maintenance treatment; MS, mood stabilizer; AAP, atypical antipsychotic; LTG, lamotrigine; AD, antidepressant; Li, lithium; Val, various kinds of valproic acid; OLZ, olanzapine; QTP, quetiapine; RIS LAI, risperidone long-acting injectable; CBZ, carbamazepine; OXC, oxcarbazepine; AD, antidepressant; CLZ, clozapine; ECT, electroconvulsive therapy; ASA, asenapine; ARP, aripiprazole; ARP OM, aripiprazole once monthly; adj, adjunctive; PAL, paliperidone; ZIP, ziprasidone; OFC, olanzapine-fluoxetine complex; FX, fluoxetine.