Objective:

In 2002, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP 2002) was published to make clinical guidelines to understand and treat bipolar disorder, but due to recent reports of various studies and application of new drugs, the revision of treatment algorithm was inevitable. Therefore, we revised the KMAP-BP 2002 focused on the treatment strategies of bipolar depression.

Method:

The methods of this survey were similar to those of the KMAP-BP 2002. The review committee consisted of 70 experienced psychi-atrists. Among the total 37 questions, 15 questions for bipolar depression were evaluated. We classified the expert opinions to 3 categories according to its confidence interval; first, second, and third line.

Results:

Compared to the previous algorithm, combination of mood stabilizers (MS) or atypical antipsychotics (AAP) and antidepressants is generally more recommended than antidepressant monotherapy for bipolar depression. Lithium and divalproex are the first-line treatment choices as well as MS. The preference for lamotrigine is increased, while that for carbamazepine is decreased. Olanzapine and quetiapine are preferred as the first-line AAP. Most antidepressants are not recommended as the first-line drug. The strategy for breakthrough of depression is changed into adding an antidepressant and/or AAP after combination of 2 MS.

Conclusion:

These results suggest that treatment of bipolar depression should be different from that of unipolar depression. The advanced new algorithm is considered to be useful and practical in the treatment of bipolar depression.