Korean J Psychopharmacol.
2006 Sep;17(5):436-448.
Korean Medication Algorithm for Bipolar Disorder 2006(III): Depressive Episode
- Affiliations
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- 1Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul, Korea.
- 2Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea. wmbahk@catholic.ac.kr
- 3Department of Psychiatry, College of Medicine, Konkuk University, Chungju, Korea.
- 4Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.
- 5Department of Psychiatry, College of Medicine, Hallym University, Anyang, Korea.
- 6Department of Psychiatry, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
- 7Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea.
- 8Naju National Hospital, Naju, Korea.
- 9Department of Psychiatry and Stress Research Institute, College of Medicine, Inje University, Seoul, Korea.
- 10Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea.
- 11Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea.
- 12Korean College of Neuropsychopharmacology, Korean Society for Depressive and Bipolar Disorders, and Korean Academy of Schizophrenia, Seoul, Korea.
Abstract
OBJECTIVE
In 2002, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP 2002) was published to make clinical guidelines to understand and treat bipolar disorder, but due to recent reports of various studies and application of new drugs, the revision of treatment algorithm was inevitable. Therefore, we revised the KMAP-BP 2002 focused on the treatment strategies of bipolar depression. METHOD: The methods of this survey were similar to those of the KMAP-BP 2002. The review committee consisted of 70 experienced psychiatrists. Among the total 37 questions, 15 questions for bipolar depression were evaluated. We classified the expert opinions to 3 categories according to its confidence interval; first, second, and third line.
Results
Compared to the previous algorithm, combination of mood stabilizers (MS) or atypical antipsychotics (AAP) and antidepressants is generally more recommended than antidepressant monotherapy for bipolar depression. Lithium and divalproex are the first-line treatment choices as well as MS. The preference for lamotrigine is increased, while that for carbamazepine is decreased. Olanzapine and quetiapine are preferred as the first-line AAP. Most antidepressants are not recommended as the first-line drug. The strategy for breakthrough of depression is changed into adding an antidepressant and/or AAP after combination of 2 MS.
CONCLUSION
These results suggest that treatment of bipolar depression should be different from that of unipolar depression. The advanced new algorithm is considered to be useful and practical in the treatment of bipolar depression.
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