Korean J Psychopharmacol.
2014 Apr;25(2):43-56.
Korean Medication Algorithm for Bipolar Disorder 2014: Overview
- Affiliations
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- 1Department of Psychiatry, Naju National Hospital, Naju, Korea.
- 2Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. wmbahk@catholic.ac.kr
- 3Department of Psychiatry, Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea.
- 4Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea.
- 5Department of Psychiatry, Konkuk University Chungju Hospital, School of Medicine, Konkuk University, Chungju, Korea.
- 6Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University and Paik Institute for Clinical Research, Department of Health Science and Technology, Graduate School of Inje University, Busan, Korea.
- 7Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
- 8Department of Psychiatry, Jeju National University Hospital, Jeju, Korea.
- 9Department of Psychiatry, Keyo Hospital, Keyo Medical Foundation, Uiwang, Korea.
- 10Department of Psychiatry, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea.
- 11Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea.
Abstract
OBJECTIVE
The Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) was firstly published in 2002, with updates in 2006 and 2010. This third update reviewed the experts' consensus of opinion on the pharmacological treatments of bipolar disorder.
METHODS
The newly revised questionnaire composed of 55 key questions about clinical situations including 223 sub-items was sent to the experts. Sixty-four of 110 experts replied. For the newly added section (treatment guideline for child and adolescent bipolar disorders) in KMAP-BP 2014, 23 of 38 experts replied to this special section. Data were analyzed according to the same methods to be used in conjunction with the previous publications.
RESULTS
The recommendations for the management of acute mania remained largely unchanged. Combination of mood stabilizer (MS) and atypical antipsychotic (AAP) was the first-line treatment option in acute mania. Valproic acid (VP), lithium (Li), and several AAPs continued to be first-line treatments. MS or AAP monotherapy was the first-line treatment in hypomania. More frequent use of AAP as a first-line agent was noted in KMAP-BP 2014. For management of mild to moderate bipolar depression, MS monotherapy, combination of MS and AAP, combination of AAP and lamotrigine (LTG) was the first-line treatments. In severe non-psychotic depression, combination of MS and AAP, combination of AAP and LTG, and combination of MS and antidepressant (AD) was the first-line treatments. For the management of severe psychotic bipolar depression, combination of MS and AAP, combination of AAP and LTG, combination of MS, AAP and AD or LTG, combination of AAP and AD, and combination of AAP, AD and LTG was the first-line treatments. Li, VP, LTG, aripiprazole (ARP), olanzapine (OLZ) and quetiapine (QT) were the first-line treatment for bipolar depression. Although many treatment options were recommended, there were few consensus of opinion in bipolar depression. Treatment of mixed features was firstly added in KMAP-BP 2014. Combination of MS and AAP was the treatment of choice for management of mixed features. AAP monotherapy was also the first-line treatment. VP, Li, ARP, OLZ and QT were the first-line treatment for management of all phases of mixed features. Risperidone was added in mixed mania and LTG in mixed depressive features. There have been many treatment options for management of rapid cycling in bipolar disorder, when considered the combination of MS and AAP was only first-line treatment in KMAP-BP 2014. Combination of MS and AAP, MS or AAP monotherapy was the first-line options for management of maintenance phase after manic episode. For maintenance treatment after bipolar I depression, combination of MS and AAP, combination of MS and LTG, combination of AAP and LTG, MS or LTG monotherapy, and combination of MS, AAP and LTG were the first-line options. For management of maintenance phase of bipolar II depression, combination of AAP and LTG, combination of MS and LTG, combination of MS and AAP, AAP or LTG monotherapy were recommended as the first-line options.
CONCLUSION
The experts' opinion of consensus was markedly changed in KMAP-BP 2014 than in previous publications. Preferred treatment with AAP and LTG was especially noted for management of bipolar disorder. We confirmed the treatment options recommended in KMAP-BP 2014 were much in concordance with current updated treatment guidelines for bipolar disorder. Despite the limitations of expert consensus guideline, KMAP-BP 2014 may reflect the current patterns of clinical practice and recent researches.
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