J Korean Neuropsychiatr Assoc.  2022 May;61(2):123-132. 10.4306/jknpa.2022.61.2.123.

Korean Medication Algorithm Project for Bipolar Disorder 2022: Depressive Episode

Affiliations
  • 1Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, 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, College of Medicine, Chosun University, Gwangju, Korea
  • 5Department of Psychiatry, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Korea
  • 6Department of Psychiatry, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
  • 7Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
  • 8Department of Psychiatry, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea
  • 9Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
  • 10Department of Psychiatry, Keyo Hospital, Uiwang, Korea
  • 11Department of Psychiatry, Jeju National University Hospital, Jeju, Korea

Abstract


Objectives
After the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, its fifth revision was completed in 2022 to reflect the recent rapid developments and research into bipolar disorder and its psychopharmacology.
Methods
According to the methodology for previous versions, the depressive episode section of KMAP-BP 2022 was revised based on a survey consisting of 11 questions. Among ninetythree experts, eighty-seven members of the review committee (93.5%) completed the survey. The executive committee analyzed the results and discussed the final production of an algorithm by considering the scientific evidence.
Results
Overall, the results from this study showed little change in comparison with previous versions of KMAP-BP. However, there have been significant changes in recommendations over the span of about 20 years. The preferences for lamotrigine and atypical antipsychotics, especially aripiprazole, quetiapine, and olanzapine, have shown a tendency to continuously increase, but the preferences for risperidone and ziprasidone have not increased, but have decreased. Moreover, the preference for typical antipsychotics has significantly decreased. Additionally, concerns over the use of antidepressants in bipolar depression have been raised, and their use is not recommended in KMAP-BP 2022 as a first-line treatment.
Conclusion
Pharmacotherapy for acute depressive episodes with various clinical progressions and various subtypes still shows diversity, compared to pharmacotherapy for mania. We look forward to the development of bipolar depressive, episode-specific therapeutic drugs in the future, and hope the fifth update of KMAP-BP will be a complementary option for clinicians and their patients with bipolar disorder.

Keyword

Bipolar disorder; Depressive episode; Pharmacotherapy; KMAP-BP 2022
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