양극성 장애의 한국형 약물치료 알고리듬 (IV): 급속순환
Treating rapid cycling bipolar disorder has many clinical problems such as recurrence, treatment resistance, and unstable course. Recent developments of medications including atypical antipsychotics and new anticonvulsants make it difficult to choose appropriate pharmacological options. The Korean Society of Psychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder including rapid cycling to aid clinical decisions.
The first survey was performed with the questionnaire based on ‘The Expert Consensus Guideline Series - Medication Treatment of Bipolar Disorder 2000'. Because of inconsistency among experts in some aspects, we carried out the second survey and discussed with related literature to make a proper algorithm.
Generally no ‘treatment of choice' were demonstrated. The first-line treatment is the single mood stabilizer or combination of a mood stabilizer and an atypical antipsychotic. Another mood stabilizer or an antidepressant can be added for the next treatment. Lithium, divalproex, and carbamazepine than the third generation mood stabilizers such as lamotrigine and topiramate are preferred as a mood stabilizer.
With the results of two surveys and discussion in executive committee, we developed the algorithm for rapid cycling bipolar disorder.