Bipolar Treatment Guidelines

Question 1

General treatment guidelines: first-line treatment for mania

Answer 1

2 or 3-drug combination that includes:

Li, VPA, or SGA PLUS a BZD (lorazepam or clonazepam) AND/OR APS for short-term augmentation for agitation or insomnia

Question 2

General treatment guidelines: first-line treatment for hypomania

Answer 2

optimize current mood stabilizer or initiate mood stabilizing medication (Li, VPA, CBZ, SGA)

Question 3

For hypomania what can you consider adding for short-term augmentation therapy or PRN insomnia?

Answer 3

BZD

Question 4

General treatment guidelines: first-line treatment for severe depressive episode

Answer 4

optimize current mood stabilizer or initiate mood-stabilizing medication that includes Li, quetiapine, or lurasidone

Question 5

Alternate treatments for severe depressive episode

Answer 5

Olanzapine/fluoxetine

Alternate AEDs: LTG, VPA

Question 6

If psychosis is present in a severe depressive episode, what can you add?

Answer 6

SGA (if the patient isn’t on one already)

Question 7

General treatment guidelines: first-line treatment for mild-moderate depressive episode

Answer 7

initiate and/or optimize mood stabilizing medication that includes Li, quetiapine, or lurasidone/Latuda

Question 8

Alternate treatment option for mania

Answer 8

CBZ

Question 9

Alternate treatment options for mild-moderate depressive episode

Answer 9

LTG, VPA, SGAs, olanzapine/fluoxetine