The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for
Bipolar Disorder 2018 (KMAP-BP 2018) with other recently published guidelines for treating
bipolar disorder. We reviewed a total of five recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2018 with those of other guidelines. For initial treatment of
mania, there were no significant differences across treatment guidelines. All guidelines recommended mood stabilizer (MS) or atypical
antipsychotic (
AAP) monotherapy or a combination of an MS with an
AAP as a first-line treatment strategy for
mania. However, the KMAP-BP 2018 did not prefer monotherapy with MS or
AAP for psychotic
mania.
Quetiapine,
olanzapine and
aripiprazole were the first-line AAPs for nearly all phases of
bipolar disorder across guidelines. Most guidelines advocated newer AAPs as first-line treatment options for all phases while
lamotrigine was recommended for depressive and maintenance phases.
Lithium and
valproic acid were commonly used as MSs in all phases of
bipolar disorder. As research evidence accumulated over time, recommendations of newer AAPs (such as
asenapine,
cariprazine,
paliperidone, lurasidine, long-acting
injectable risperidone and
aripiprazole once monthly) became prominent. KMAP-BP 2018 guidelines were similar to other guidelines, reflecting current changes in prescription patterns for
bipolar disorder based on accumulated research data. Strong preference for combination
therapy was characteristic of KMAP-BP 2018, predominantly in the treatment of psychotic
mania and severe depression. Further studies were needed to address several issues identified in our review.