Table 1 Guidelines for the treatment of bipolar disorder

TMAP, 2002

First step:

Li, Vp, Olz

Second step:

Various combinations of two first choice agents

First step:

Li, Vp, Olz, Li/Vp/Olz + SSRI/La

Second step:

Various combinations of two or more first choice agents, ECT

First step:

Li, Vp, Olz, monotherapy or +AD (intermittent use)

Second step:

Various combinations of two or more first choice agents

WFSBP, 2003

First step:

Li, Vp, Olz, Ris, Cbz

Second step:

Combinations of MS+aAPs, ECT

First step:

AD+MS, SSRIs + Li/La/Vp/Cbz

Second step:

Combination of first choice agents, augmentation strategies, ECT

First step:

After depression:

AD+MS, SSRIs + Li/La/Vp/Cbz After mania: Li, MS, AP

Second step:

Combination of first choice agents

APA, 2002 and 2007

First step:

Severe: Li/Vp+AP

Mild-Moderate: Li, Vp, Olz

Second step:

Various combinations of two first choice agents, ECT

2007 update:

Li for classic mania, Vp for mixed episodes, Cbz, Olz, Li/Vp+AP, ECT

First step:

Li, La, Li+AD, ECT

Second step:

Various combinations of two first choice agents, ECT

2007 update:

Li, Vp, La, MAOIs, SSRIs, Venf, TCAs, OFC, ECT

First step:

Li, Vp, possibly Cbz, La, Ocbz. Continue the treatment proved efficient during the acute phase

Second step:

ECT, combination of first choice agents. AP should be discontinued

2007 update:

Li, Vp, La, ECT

CANMAT, 2007

First step:

Li, Vp, Olz, Ris, Quet, Arip, Zip, Li/Vp+Ris/Quet/Olz

Second step:

Cbz, Ocbz, ECT, Li+Vp

Third step:

Hal, Clpz, Li/Vp+Hal, Li+Cbz, Cloz

First step:

Li, La, Li/Vp+SSRI, Olz+SSRI, Li/Vp+Bupr, Quet

Second step:

Quet+SSRI, Li/Vp+La

Third step:

Cbz, Olz, Vp, Li+Cbz, Li+Pramx, Li/Vp+Venf, Li+MAOI, ECT, Li/Vp/AAP+TCA, Li/Vp/Cbz+SSRI+La, adjunctive EPA/riluzole/topiramate

First step:

Li, La, Vp, Olz

Second step:

Cbz, Li+Vp/Cbz, Li/Vp+Olz, Arip, Ris, Quet, Zip, Li+Ris/Quet, Li+La/SSRI/Bupr, OFC

Third step:

Adjunctive flupenthixol, gabapentin, topiramate, AD

NICE, 2006

First step:

Severe: Olz, Quet, Ris. Li/Vp only in patients that previously responded to these agents. BZ if necessary Milder forms: Li/Vp

Second step:

Li/Vp+APP

Third step:

ECT

First step:

SSRI+AM

Second step:

SSRI+Li/Vp+Quet, Mrz/Venf+AM

Third step:

ECT

First step:

Discontinuation of Ads, keep Li/Olz/Vp

Second step:

Combinations of first step agents

Third step:

Combinations of first step agents plus La/Cbz