Table 1.

Recommended Line of Treatment

Level of Recommendation	Recommendation	Treatment
First-line	Physical examination and workup should be performed; trigger factors should be evaluated; if antidepressants are being taken, they should be stopped; emergency situations should be assessed and if an emergency is present, precautions should be taken.	Monotherapy - quetiapine, risperidone, valproate, lithium; if an emergency is present, olanzapine, haloperidol
Second-line	Compliance to the treatment should be assessed; if there is no response to the first line of treatment despite adequate dose and period of medication, the second line should be implemented.	Monotherapy - olanzapine, haloperidol, carbamazepine; Along with MS - olanzapine, aripiprazole, haloperidol, quetiapine, risperidone, paliperidone
Third-line	Factors that might complicate treatment should be assessed; personal and family history should be examined in detail.	Electroconvulsive therapy in addition to pharmacological treatment; for patients who present mixed features ziprasidone
Fourth-line	Treatments with low levels of evidence can be utilized; drugs recommended at the earlier lines of treatment can be tried.	Chlorpromazine, pimozide, tamoxifen, allopurinol

The recommendations in the table are based on the beneficial and adverse effect profiles of the drugs. MS: Mood Stabilizers