Table 2.
Levels of evidence and lines of treatment accepted in the bipolar disorder treatment guidelines published in the past 10 years for the treatment of manic episodes.
| CANMAT | WFSBP* | CINP | RANZCP | |||
|---|---|---|---|---|---|---|
| LOE | LOT | LOE1 | LOT2 | LOE | LOE | |
| Lithium | 1 | 1 | F/F | 3/5 | 2 | 1 |
| Valproate | 1 | 1 | C/F | 4/3 | 1 | 1 |
| Carbamazepine | 1 | 2 | C/F | 4/- | 4 | 1 |
| Risperidone | 1 | 1 | C/E | 4/4 | 1 | 1 |
| Quetiapine | 1 | 1 | E/C | 3/2 | 1 | 1 |
| Olanzapine | 1 | 2 | A/A | 2/3 | 2 | 1 |
| Aripiprazole | 1 | 1 | B/F | 3/- | 1 | 1 |
| Paliperidone | 1 | 1 | B/E | 3/- | - | 2 |
| Cariprazine | 1 | 1 | C/F | 4/- | - | - |
| Asenapine | 1 | 1 | E/F | 4/- | 1 | 2 |
| Ziprasidone | 1 | 2 | C/F | 3/4 | - | 1 |
| Haloperidol | 1 | 2 | C/E | 4/- | 2 | 1 |
| Electroconvulsive Therapy | 3 | 2 | F/C | 4/- | 4 | - |
LOE: Level of Evidence, LOT: Line of Treatment, CANMAT: Canadian Network for Mood and Anxiety Disorders, WFSBP: World Federation of Societies of Biological Psychiatry, CINP: International College of Neuropsychopharmacology, RANZCP: Royal Australian and New Zealand College of Psychiatrists.
Manic episodes with mixed features, A: Clear evidence from controlled studies, B: Unclear evidence from controlled studies, C: Evidence obtained from uncontrolled studies, D: Contradictory information, E: Negative evidence, F: Inadequate information; 1Monotherapy/combination; 2Treatment for acute mixed manic episode/Prevention of mixed manic episodes.