Phase | Treatment |
---|---|
Acute mania | Antipsychotics: aripiprazole (15-30 mg/day) Aripiprazole Alone or in Combination for Acute Mania, asenapine (10-20 mg/day), haloperidol (2-15 mg/day), cariprazine (1.5-6 mg/day), quetiapine (300-800 mg/day), olanzapine (5-20 mg/day), risperidone (1-6 mg/day) or ziprasidone (80-120 mg/day) |
Lithium (target concentration 0.80-1.20 mmol/l) | |
Valproic acid* (target concentration 450-900 μmol/l) Valproate in the Treatment of Mania | |
Carbamazepine (400-1 600 mg/day) | |
Mood stabilizers and antipsychotics in combination | |
Electroconvulsive therapy (in selected therapy-resistant or psychotic cases) | |
Depression episode | Lamotrigine (50-200 mg/day) |
Lithium (target concentration 0.80-1.20 mmol/l) | |
Valproic acid* (target concentration 450-600 µmol/l) | |
Olanzapine + fluoxetine 5 + 20 - 10 + 40 mg/day | |
Lurasidone (20-120 mg/day) | |
Cariprazine (1.5 mg/day) | |
Quetiapine (300-600 mg/day) | |
Antidepressants (only in combination with mood stabilizers; discontinued gradually when remission is achieved) | |
Electroconvulsive therapy (ECT) | |
Mixed episode | Treatment as in mania (but specific evidence of efficacy for mixed episodes is absent for haloperidol, quetiapine and lithium) |
Maintenance treatment | Lithium (target concentration 0.60-0.80 mmol/l) |
Carbamazepine (400-1 600 mg/day) | |
Valproic acid* (target concentration 450-900 μmol/l) | |
Lamotrigine (50-400 mg/day; not as monotherapy in type I) | |
Aripiprazole (15-30 mg/day), quetiapine (300-600 mg/day) or olanzapine (5-20 mg/day); depot risperidone (25-50 mg/2 weeks) | |
The above drugs in combination |
Valproic acid is highly teratogenic. It should not be prescribed for women if there is a possibility of becoming pregnant. | |
Treatment of mania and hypomania Topiramate for Acute Affective Episodes in Bipolar Disorder in Adults, Lithium for Acute Mania
Treatment of bipolar depression
Treatment of mixed episodes
Maintenance therapy
Psychosocial treatment in specialized care
Cyclothymia
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