Korean J Psychopharmacol.
2002 Sep;13(3):205-221.
Korean Medication Algorithm for Bipolar Disorder(I)
- Affiliations
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- 1Department of Psychiatry, College of Medicine, Catholic University, Seoul, Korea.
- 2Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea.
- 3Department of Psychiatry, Ilsan Hospital, National Health Insurance Corporation, Koyang, Korea.
- 4Naju National Hospital, Naju, Korea.
- 5Department of Psychiatry, Eulji University School of Medicine, Seoul, Korea.
- 6Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.
- 7Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul, Korea. mind61@chollian.net
Abstract
OBJECTIVE
Treating patients with bipolar disorder has many problems such as recurrent various episodes, breakthroughs, treatment resistance, switching and worsening of its course. In addition to these obstacles, recent developments of psychiatric medications make it difficult to choose the appropriate pharmacological options. This study was performed to survey the expert opinion of medication treatment for bipolar disorder.
METHODS
The survey questionnaire used in 'The Expert Consensus Guideline Series-Medication Treatment of Bipolar Disorder 2000' was translated in Korean and amended by executive committee according to Korean situations. Forty eight of 50 (96%) members of review committee completed the survey.
RESULTS
In acute manic episode lithium or divalproex is a first-line drug as a monotherapy, and combination treatment is considered in partial or non-responder. Carbamazepine is also a first-line drug in dysphoric and mixed episodes. For moderate and more severe depression, an antidepressant is added with a mood stabilizer. For psychotic bipolar disorder, mania or depression, both atypical antipsychotics and high potency typical antipsychotics are preferred, but the latter is less likely to be recommended. A mood stabilizer should be used in rapid cycling bipolar illness. For manic episode in rapid cycler a mood stabilizer and an atypical antipsychotic drug are recommended in combination as an initial treatment.
CONCLUSION
Most experts present strong consensus for many options concerning to initial strategies and first-line medications, although there are some non-consensus and gaps between research data and clinical usage in some steps. Nevertheless these data might be a cornerstone for producing the Korean medication algorithm for bipolar disorder.
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