Korean J Psychopharmacol.
2003 Dec;14(4):336-346.
Korean Medication Algorithm for Bipolar Disorder(III): Depressive Episode
- Affiliations
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- 1Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul, Korea.
- 2Department of psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea.
- 3Department of Psychiatry, Ilsan Hospital, National Health Insurance Corporation, Goyang, Korea.
- 4Naju National Hospital, Naju, Korea.
- 5Department of Psychiatry, College of Medicine, Catholic University, Seoul, Korea.
- 6Department of Psychiatry, College of Medicine, Catholic University, MARY'S Hospital, Seoul, Korea.
Abstract
OBJECTIVE
Treating depressive episode of bipolar disorder has many clinical problems such as recurrence, treatment resistance, switching and worsening of its course. Recent developments of medications including atypical antipsychotics and new antidepressants make it difficult to choose appropriate pharmacological options. The Korean Society of Psychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder including depressive episode of bipolar disorder to aid clinical decisions. METHODS: The first survey was performed with the questionnaire based on `The Expert Consensus Guideline Series-Medication Treatment of Bipolar Disorder 2000'. Because of inconsistency among experts in some aspects, we carried out the second survey and discussed with related literature about bipolar depression to make a proper algorithm. RESULTS: A mood stabilizer, such as lithium or divalproex, is recommended for treating mild bipolar depression. For moderate and nonpsychotic severe bipolar depression, the first-line treatment option is a combination of antidepressant and mood stabilizer, with which a high potency antipsychotic or atypical antipsychotic drug is combined for bipolar depression with psychotic features. In the case of poor or no response to the initial treatment, to add or change antidepressant is a next step of treatment strategy. In refractory bipolar depression, thyroid hormone, atypical antipsychotics, or other mood stabilizers are recommended. Electroconvulsive therapy (ECT) can be used at any point, if needed, by the decision of clinicians. CONCLUSION: With the results of two surveys and discussion in the executive committee, we developed the algorithm for depressive episode of bipolar disorder.
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