Korean Medication Algorithm for Bipolar Disorder 2014: comparisons with other treatment guidelines

Figures & data

Table 1 Summary of recent bipolar disorder treatment guidelines

Organization	Publication date	Audience	Methodology
KMAP-BP	2014^Citation12	Psychiatrists	Expert consensus
BAP	2009^Citation13	Psychiatrists	Evidence-based
		Primary care physicians
CANMAT	2013^Citation14	Psychiatrists	Evidence-based
NICE	2014^Citation15	Psychiatrists	Evidence-based
		Primary care physicians
WFSBP	2009 (acute mania, mixed, rapid cycling)^Citation16	Psychiatrists	Evidence-based
	2013 (maintenance)^Citation18	Primary care physicians
	2010 (acute depression)^Citation17

Abbreviations: KMAP-BP, Korean Medication Algorithm Project for Bipolar Disorder; BAP, British Association for Psychopharmacology; CANMAT, Canadian Network for Mood and Anxiety Treatments; NICE, National Institute for Health and Clinical Excellence; WFSBP, World Federation of Societies of Biological Psychiatry.

Table 2 Treatment of acute euphoric/classic mania across practice guidelines

Guidelines	First-line treatment	Next-step intervention	Later intervention
KMAP-BP 2014^Citation12	Li, Val, Li or Val + AAP	Li or Val + AAP, Li or Val + two AAPs, Val + Li + AAP	Two AAPs + Li + Val, Li + Val + other AAP
BAP 2009^Citation13	Mild: AP or Val or Li (or CBZ)	Li or Val + AP	ECT or CLZ
	Severe: AP or Val (if required IM: AP or BZ)
CANMAT 2013^Citation14	Li, Val, OLZ, RIS, QTP, QTPXR, ARP, ZIP, ASP, PAL	CBZ, ECT, HP, Li + Val	CPZ, CLZ, OXC, tamoxifen, cariprazine, Li or VAL + HP, Li + CBZ, adjunctive tamoxifen
	Adjunctive with MS: RIS, QTP, OLZ, ARP, ASP
NICE 2014^Citation15	Without AM: HP, OLZ, QTP, OLZ	Alternative AP or adding Li or Val	ECT
	With Li: optimization, adding HP, OLZ, QTP, RIS
WFSBP 2009^Citation16	Monotherapy with CE 1 and RG A such as Val, ARP, ZIP, and RIS	Optimize dosage; switch to another first-line agent; in severe mania, consider combination	Add-on with first-line agent; combination of two first-line choices

Abbreviations: KMAP-BP 2014, Korean Medication Algorithm Project for Bipolar Disorder 2014; BAP 2009, The British Association for Psychopharmacology Guidelines for Treatment of Bipolar Disorder 2009; CANMAT 2013, Canadian Network for Mood and Anxiety Treatments Clinical Guidelines for the Management of Patients with Bipolar Disorder 2013; NICE 2014, National Institute for Health and Clinical Excellence Clinical Guideline for Bipolar Disorder 2014; WFSBP 2009, World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Bipolar Disorder 2009 (treatment of acute mania); Li, lithium; Val, various kinds of valproic acids; AAP, atypical antipsychotic; AP, antipsychotics; CBZ, carbamazepine; IM, intramuscular formulation; BZ, benzodiazepine; ECT, electroconvulsive therapy; CLZ, clozapine; OLZ, olanzapine; RIS, risperidone; QTP, quetiapine; QTPXR, quetiapine XR; ARP, aripiprazole; ZIP, ziprasidone; ASP, asenapine; PAL, paliperidone; HP, haloperidol; CPZ, chlorpromazine; OXC, oxcarbazepine; AM, antimanic agents; CE, categories of evidence; RG, recommendation of grade.

Table 3 Treatment of mixed/psychotic mania across practice guidelines

Guidelines	First-line treatment	Next-step intervention	Later intervention
KMAP-BP 2014^Citation12	Mixed mania: Val or Li + AAP	Li or Val + AAP, Li or Val +	Two AAPs + Li + Val, Li +
	Psychotic mania: Val or Li + AAP, AAP	two AAPs, Val + Li + AAP	Val + other AAP
BAP 2009^Citation13	Same as for euphoric mania; AAP in psychotic mania	Same as for euphoric mania	Same as for euphoric mania
CANMAT 2013^Citation14	Not mentioned
NICE 2014^Citation15	Same as for euphoric mania	Same as for euphoric mania	Same as for euphoric mania
WFSBP 2009^Citation16	Val, AAP (OLZ, ZIP, ARP)	RIS, CBZ

Abbreviations: KMAP-BP 2014, Korean Medication Algorithm Project for Bipolar Disorder 2014; BAP 2009, The British Association for Psychopharmacology Guidelines for Treatment of Bipolar Disorder 2009; CANMAT 2013, Canadian Network for Mood and Anxiety Treatments Clinical Guidelines for the Management of Patients with Bipolar Disorder 2013; NICE 2014, National Institute for Health and Clinical Excellence Clinical Guideline for Bipolar Disorder 2014; WFSBP 2009, World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Bipolar Disorder 2009 (treatment of acute mania); Val, various kinds of valproic acids; Li, lithium; AAP, atypical antipsychotic; OLZ, olanzapine; ZIP, ziprasidone; ARP, aripiprazole; RIS, risperidone; CBZ, carbamazepine.

Table 4 Treatment of bipolar depression across practice guidelines

Guidelines	First-line treatment	Next-step intervention	Later intervention
KMAP-BP 2014^Citation12	Mild to moderate: MS, MS + AAP, AAP + LTG	Mild to moderate: AAP, LTG, add AAP or MS or LTG, change AAP	Add or change AAP or MS or LTG or AD, add stimulant or thyroid hormone, buspirone, ECT, or CLZ
	Nonpsychotic severe: MS + AAP, LTG + AAP, MS + AD	Nonpsychotic severe: add AAP or MS or LTG or AD, change MS to LTG
	Psychotic: AAP + (MS or LTG or AD), AAP + MS + LTG, AAP + AD + MS (or LTG)	Psychotic: add MS or LTG or AD, change AAP, change MS to LTG
BAP 2009^Citation13	Mild and/or previous mood instability: QTP or LTG	Add antimanic agent if BP-I
	Moderate: QTP or LTG, SSRI or other AD (not TCA)
	Consider ECT in severe depression
CANMAT 2013^Citation14	Li, LTG, QTP, QTPXR, Li or Val + SSRI, OLZ + SSRI, Li + Val, Li or Val + BUP	Val, lurasidone, QTP + SSRI, Li or Val + LTG, adjunctive MDF, Li or Val + lurasidone	CBZ, OLZ, ECT, Li + CBZ, Li + pramipexole, Li or Val + VEN, Li + MAOI, Li or Val or AAP + TCA, Li or Val or CBZ + SSRI + LTG, QTP + LTG
NICE 2014^Citation15	Without AM: OLZ + FX, QTP, OLZ, LTG	Adding LTG
	With MS: optimization, adjunctive OLZ + FX, adjunctive QTP, adjunctive OLZ, adjunctive LTG
WFSBP 2010^Citation17	QTP, adjunctive QTP, OFC, OLZ, LTG, LTG + Li, Val	Optimization of first-line treatment, QTP, add CBZ, Li, MDF + Li/Val/ADs, ECT

Abbreviations: KMAP-BP 2014, Korean Medication Algorithm Project for Bipolar Disorder 2014; BAP 2009, The British Association for Psychopharmacology Guidelines for Treatment of Bipolar Disorder 2009; CANMAT 2013, Canadian Network for Mood and Anxiety Treatments Clinical Guidelines for the Management of Patients with Bipolar Disorder 2013; NICE 2014, National Institute for Health and Clinical Excellence Clinical Guideline for Bipolar Disorder 2014; WFSBP 2010, World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Bipolar Disorder 2010 (treatment of acute bipolar depression); MS, mood stabilizer; AAP, atypical antipsychotic; LTG, lamotrigine; AD, antidepressant; ECT, electroconvulsive therapy; CLZ, clozapine; QTP, quetiapine; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant; BP-I, bipolar I disorder; Li, lithium; QTPXR, quetiapine XR; Val, various kinds of valproic acids; OLZ, olanzapine; BUP, bupropion; MDF, modafinil; CBZ, carbamazepine; VEN, venlafaxine; MAOI, monoamine oxidase inhibitor; AM, antimanic agents; FX, fluoxetine; OFC, olanzapine–fluoxetine combination.

Table 5 Treatment of rapid cycling across practice guidelines

Guidelines	First-line treatment	Next-step intervention	Additional comments
KMAP-BP 2014^Citation12	Currently manic: MS + AAP, AAP	Currently manic: two MSs + AAP; change AAP or MS, ECT	Change AAP to CLZ or add other AAP, MS (including CBZ), ECT
	Currently depressed: MS + AAP, AAP, MS, or AAP + LTG	Currently depressed: change or add MS, MS + AAP + LTG, add AD, ECT
BAP 2009^Citation13	No recommendation
CANMAT 2013^Citation14	Not mentioned
NICE 2014^Citation15	Same as with other types of bipolar disorder
WFSBP 2009^Citation16	Not mentioned

Abbreviations: KMAP-BP 2014, Korean Medication Algorithm Project for Bipolar Disorder 2014; BAP 2009, The British Association for Psychopharmacology Guidelines for Treatment of Bipolar Disorder 2009; CANMAT 2013, Canadian Network for Mood and Anxiety Treatments Clinical Guidelines for the Management of Patients with Bipolar Disorder 2013; NICE 2014, National Institute for Health and Clinical Excellence Clinical Guideline for Bipolar Disorder 2014; WFSBP 2009, World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Bipolar Disorder 2009 (treatment of acute mania); MS, mood stabilizer; AAP, atypical antipsychotic; LTG, lamotrigine; ECT, electroconvulsive therapy; AD, antidepressant; CLZ, clozapine; CBZ, carbamazepine.

Table 6 Continuation and maintenance treatment across practice guidelines

Guidelines	First-line treatment	Next-step intervention	Later intervention
KMAP-BP 2014^Citation12	BP-I, recently manic: MS + AAP, MS, AAP	BP-I, recently manic: MS + LTG, two MSs	Recently manic and hypomanic: AAP + LTG, MS + AAP + LTG, AAP + MS + AD, LTG
	BP-I in breakthrough mania: optimization, MS + AAP, add AAP	BP-I in breakthrough mania: Li or Val + other MS, change MS	BP-I in breakthrough mania: optimize/change MS
	BP-II, recently hypomanic: MS, AAP, MS + AAP	BP-I, recently depressed: two MSs, MS + AAP + LTG	BP-I, recently depressed: AAP + AD, MS + AAP + AD, MS + AD
	BP-I and BP-II, recently depressed: AAP or MS + LTG, MS + AAP, MS, AAP, LTG	BP-II, recently hypomanic: AAP + LTG, MS + LTG	BP-II, recently depressed: MS + AAP + AD, AAP + AD + LTG
		BP-II, recently depressed: AAP + MS + LTG, MS + AD
BAP 2009^Citation13	If mania predominates: Li, ARP, QTP, Val, OLZ	If mania predominates: CBZ	Combination therapy: CLZ
	If depression predominates: QTP, LTG	If depression predominates: Li
CANMAT 2013^Citation14	Li, LTG (limited efficacy in preventing mania), Val, OLZ, QTP, RIS LAI, ARP, adjunctive with MS: QTP, RIS LAI, ARP, ZIP	CBZ, PAL, Li + Val, Li + CBZ, Li or Val + OLZ, Li + RIS, Li + LTG, OLZ + FX	ASA
			Adjunctive phenytoin, adjunctive CLZ, adjunctive ECT, adjunctive TP, adjunctive omega-3-fatty acid, adjunctive OXC, or adjunctive gabapentin Adjunctive ASA
NICE 2014^Citation15	Li	Val, OLZ, QTP
WFSBP 2013^Citation18	ARP (mania and any episode), LTG (depression and any episode), Li (any episode), QTP (any episode)	OLZ (mania and any episode), RIS (mania and any episode)	AD (depression), PAL (mania and any episode), Val (depression), adjunctive ZIP (mania and any episode)

Abbreviations: KMAP-BP 2014, Korean Medication Algorithm Project for Bipolar Disorder 2014; BAP 2009, The British Association for Psychopharmacology Guidelines for Treatment of Bipolar Disorder 2009; CANMAT 2013, Canadian Network for Mood and Anxiety Treatments Clinical Guidelines for the Management of Patients with Bipolar Disorder 2013; NICE 2014, National Institute for Health and Clinical Excellence Clinical Guideline for Bipolar Disorder 2014; WFSBP 2013, World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Bipolar Disorder 2013 (maintenance treatment); BP-I, bipolar I disorder; MS, mood stabilizer; AAP, atypical antipsychotic; BP-II, bipolar II disorder; LTG, lamotrigine; Li, lithium; Val, various kinds of valproic acids; AD, antidepressant; ARP, aripiprazole; QTP, quetiapine; OLZ, olanzapine; CBZ, carbamazepine; CLZ, clozapine; RIS LAI, risperidone long-acting injection; ZIP, ziprasidone; PAL, paliperidone; RIS, risperidone; FX, fluoxetine; ASA, asenapine; ECT, electroconvulsive therapy; TP, topiramate; OXC, oxcarbazepine.

WooYSLeeJGJeongJHKorean medication algorithm project for bipolar disorder: third revisionNeuropsychiatr Dis Treat20151149350625750530

 PubMed Web of Science ®Google Scholar

GoodwinGMEvidence-based guidelines for treating bipolar disorder: revised second edition – recommendations from the British Association for PsychopharmacologyJ Psychopharmacol200923434638819329543

 PubMed Web of Science ®Google Scholar

YathamLNKennedySHParikhSVCanadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013Bipolar Disord201315114423237061

 PubMed Web of Science ®Google Scholar

National Collaborating Centre for Mental HealthBipolar Disorder: The Assessment and Management of Bipolar Disorder in Adults, Children and Young People in Primary and Secondary CareLeicester UKThe British Psychological Society; The Royal College of Psychiatrists2014

 Google Scholar

GrunzeHVietaEGoodwinGMThe World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2009 on the treatment of acute maniaWorld J Biol Psychiatry20091028511619347775

 PubMed Web of Science ®Google Scholar

GrunzeHVietaEGoodwinGMWFSBP Task Force on Treatment Guidelines for Bipolar Disorders. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the long-term treatment of bipolar disorderWorld J Biol Psychiatry201314315421923480132

 PubMed Web of Science ®Google Scholar

GrunzeHVietaEGoodwinGMWFSBP Task Force On Treatment Guidelines For Bipolar Disorders. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2010 on the treatment of acute bipolar depressionWorld J Biol Psychiatry20101128110920148751

 PubMed Web of Science ®Google Scholar