한국형 양극성 장애 약물치료 알고리듬 2010 : 우울 삽화

Abstract

Background and Objectives : Since we published the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) in 2006, we performed the revision of the KMAP-BP in 2010 in order to reflect recent studies for bipolar disorder. Materials and Method : To compare the results reciprocally, the design and methods of this study were similar to those of the KMAP-BP 2006. The review committee consisted of 94 experienced psychiatrists. Among the total 40 questions, 14 questions for bipolar depression were evaluated. We classified the expert opinions to 3 categories according to its confidence interval. Results : As an initial first-line pharmacological treatment strategy, mood stabilizer (MS) or lamotrigine monotherapy for mild to moderate bipolar depression were recommended, and combination of atypical antipsychotics (AAP), MS and antidepressant (AD) was recommended for severe bipolar depression regardless of accompanying psychotic symptoms. Lamotirigine as well as lithium and valproate were the first-line MS. Quetiapine, olanzapine, and aripiprazole were preferred as the first-line AAP. Although anti-depressant monotherapy were not recommended as a first-line treatment strategy for bipolar depression, bupropion and (es)citalopram were recommended as the first-line AD. In case of inadequate response for initial pharmacological treatment, adding other MS or AAP rather than change was preferred. Conclusion : These results implicate that treatment of bipolar depression is different from that of unipolar depression. Study of pharmacological treatment for bipolar II disorder would be needed. (J of Kor Soc for Dep and Bip Disorders 2011;9:96-102)