Mood Emot.  2018 Jul;16(2):57-68. 10.0000/me.2018.16.2.57.

Korean Medication Algorithm for Bipolar Disorder 2018 : Depressive Episode

Affiliations
  • 1Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea.
  • 2Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea. wmbahk@catholic.ac.kr
  • 3Department of Psychiatry, Naju National Hospital, Naju, Korea.
  • 4Department of Psychiatry, Sacred Heart Hospital, Hallym University, Anyang, Korea.
  • 5Department of Psychiatry, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea.
  • 6Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University and Paik Institute for Clinical Research, Busan, Korea.
  • 7Department of Health Science and Technology, Graduate School of Inje University, Busan, 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, Soonchunhyang University, Cheonan, Korea.
  • 11Department of Psychiatry, Myongji Hospital, Goyang, Korea.
  • 12Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea.

Abstract


OBJECTIVES
Since the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, the fourth revision of KMAP-BP was completed in 2018 in order to reflect the recent rapid research and development into bipolar disorder and psychopharmacology.
METHODS
According to the methodology of previous versions, KMAP-BP 2018 was revised using a questionnaire consisting of 10 questions. Among eighty-four experts of the review committee, sixty-one completed the survey.
RESULTS
The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer (MS) combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Switching or adding AAP, lamotrigine, or MS as 2nd strategies and clozapine or augmentation of buspirone, stimulant, or thyroid hormone as 3rd strategies were recommended. Compared to the previous KMAP-BP series, preference of AAP and lamotrigine has increased in the treatment of bipolar depressive episode in KMAP-BP 2018. Among the AAPs, olanzapine, quetiapine, and aripiprazole were preferred.
CONCLUSION
Compared with the previous versions, we found that more active pharmacological strategies using AAP and lamotrigine as initial and next treatment strategies, respectively, were preferred, although few drugs were approved for bipolar depression.

Keyword

Bipolar disorder; Depressive episode; Pharmacotherapy; KMAP-BP 2018
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