Mood Emot.  2018 Jul;16(2):77-85. 10.0000/me.2018.16.2.77.

Korean Medication Algorithm for Bipolar Disorder 2018 : Rapid Cycling

  • 1Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
  • 2Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 3Department of Psychiatry, Naju National Hospital, Naju, Korea.
  • 4Department of Psychiatry, Sacred Heart Hospital, Hallym University, Anyang, Korea.
  • 5Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea.
  • 6Department of Psychiatry, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea.
  • 7Department 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.
  • 8Department of Psychiatry, School of Medicine, Jeju National University, Jeju, Korea.
  • 9Department of Psychiatry, Keyo Hospital, Keyo Medical Foundation, Uiwang, Korea.
  • 10Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University, Cheonan, Korea.
  • 11Department of Psychiatry, Myongji Hospital, Goyang, Korea.
  • 12Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea.


The objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder 2014 for rapid cycling.
The questionnaires, which were intended to survey experts for their opinions of medication used for rapid cycling, were completed by the review committee, which consisted of 84 Korean expert psychiatrists. We classified the responses into three categories. based on the lowest category in which the confidence interval fall (6.5≤ for first-line and 3.5≤ for high second-line treatment).
The first-line treatment was the combination of a mood stabilizer and an atypical antipsychotic. This combination strategy was the treatment of choice for manic episodes. Additionally, a mood stabilizer with lamotrigine therapy and an atypical antipsychotic with lamotrigine combinations were the first-line treatments for the depressive phase. Atypical antipsychotic monotherapy, mood stabilizer monotherapy, the combination of two mood stabilizers, and the triple combination of mood stabilizers, atypical antipsychotics, and antidepressants were preferred as the next strategies. The first-line medications in all cases were valproate, quetiapine, olanzapine and aripiprazole. Lithium was the first-line medication in depressive and hypomanic episodes, and lamotrigine was the first-line medication for the treatment of the depressive phase.
Compared to the surveys in 2014, the preference for atypical antipsychotics and lamotrigine have increased, and modalities used as a second-line treatment were more diverse.


Bipolar disorder; Rapid cycling; KMAP-BP 2018

MeSH Terms

Advisory Committees
Antidepressive Agents
Antipsychotic Agents
Bipolar Disorder*
Quetiapine Fumarate
Valproic Acid
Antidepressive Agents
Antipsychotic Agents
Quetiapine Fumarate
Valproic Acid
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