новые алгоритмы терапии депрессии при БАР

Algorithm for the treatment of bipolar I depression



Step 1: Treat bipolar I depression for 8 weeks with

* Quetiapine 600 mg daily
or
* Lithium 0.8 mEq/L daily (or another mood stabilizer) along with lamotrigine 50 - 200 mg daily

If there is no treatment response, move on to step 2



Step 2: For treatment-resistant bipolar I depression

* Use a combination of olanzapine 6 - 12 mg plus fluoxetine 25 - 50 mg (OFC) daily
or
* Increase dose to > 600 mg of quetiapine along with lamotrigine 50 - 200 mg daily

If there is no treatment response, move on to step 3



Step 3: Treat refractory bipolar I depression

* Adjust OFC dose
or switch to
* Lithium 0.8 mEq⁄L daily plus an SSRI 20 - 40 mg and bupropion 150 - 300 mg daily
or
* Increase dose to > 600 mg of quetiapine and 20 - 40 mg of an SSRI and 150 - 300 mg of bupropion daily
or
* Use novel therapies such as modafinil or pramipexole

If there is no treatment response, move on to step 4



Step 4: Treat intractable bipolar I depression, with

* Electroconvulsive therapy

If there is still no response, the patient may have involutional bipolar I disorder
Adapted from Pacchiarotti I et al. Acta Psychiatr Scand. 2009.1


Algorithm for the treatment of bipolar II depression



Step 1: Treatment of bipolar II depression for 8 weeks with

* Lithium 0.8 mEq/L daily (or another mood stabilizer) along with lamotrigine 50 - 200 mg daily
* Quetiapine 600 mg daily
or

If there is no treatment response, move on to step 2



Step 2: For treatment-resistant bipolar I depression, use

* Lithium 0.8 mEq⁄L daily along with an SSRI 20 - 40 mg and bupropion 150 - 300 mg daily
or
* Quetiapine 300 - 600 mg daily along with an SSRI 20 - 40 mg and bupropion 150 -300 mg daily

If there is no treatment response, move on to step 3



Step 3: Treat refractory bipolar I depression

* Adjust OFC dose or switch to
* Quetiapine 300 - 600 mg daily and a monoamine oxidase inhibitor (MAOI) such as tranylcypromine 20 - 100 mg daily
or

* Lithium 0.8 mEq⁄L daily and an MAOI such as tranylcypromine 20 - 100 mg daily
or
* Novel therapies such as modafinil or pramipexole

If there is no treatment response, move on to step 4



Step 4: Treat intractable bipolar I depression with

* Electroconvulsive therapy

If there is still no response, the patient may have involutional bipolar II disorder
Adapted from Pacchiarotti I et al. Acta Psychiatr Scand. 2009.1

New Algorithms for the Management of Treatment-Resistant Bipolar Depression