Revised Korean medication algorithm for bipolar disorder.
The rapid progress in treatments for bipolar disorder makes it necessary to revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) published in 2002. This study was performed to timely revise KMAP-BP 2002. A questionnaire comprising 37 questions and 645 treatment options was developed for surveying the opinions of Korean experts. We classified the opinions into three categories: first-, second-, and third-line treatments. Fifty-three (75.7%) of the 70 selected experts answered the questionnaire. For an acute manic episode, the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) was the preferred first-line treatment. Most experts recommended divalproex and lithium as MSs, and olanzapine, quetiapine, and risperidone as AAPs. For moderately to severely depressed bipolar patients, MS monotherapy and a combination of an MS and an antidepressant (AD) were considered to be preferred treatments respectively. A combination of an MS and an AD was the preferred strategy in severe nonpsychotic depression. Most ADs were rated as second-line drugs. Overall, the preference for lamotrigine and AAPs was higher than in KMAP-BP 2002. The algorithm was developed mainly using consensus among experts supplemented with findings of recent clinical trials to ensure that our algorithm was both up to date and balanced. These results suggest that the medication strategies of KMAP-BP are changing rapidly, reflecting recent studies and clinical experiences.
Jon
Duk-In
DI
Department of Psychiatry, Hallym University, Anyang, Korea.
Bahk
Won-Myong
WM
Yoon
Bo-Hyun
BH
Shin
Young Chul
YC
Cho
Hyun-Sang
HS
Lee
Eun
E
Ha
Kyooseob
K
Kim
Won
W
Chung
Sang Keun
SK
Seo
Jeong-Seok
JS
Min
Kyung Joon
KJ
D000465:Algorithms; D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D003987:Dibenzothiazepines / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D006282:Health Personnel; D006801:Humans; D007723:Korea / Q000453:epidemiology; D000077152:Olanzapine; D011570:Psychiatry / Q000706:statistics & numerical data; D000069348:Quetiapine Fumarate; D018967:Risperidone / Q000627:therapeutic use; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D014635:Valproic Acid / Q000627:therapeutic use*
D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D014635:Valproic Acid; D018967:Risperidone; D000077152:Olanzapine