Page 13 - e-book CPG - Bipolar Disorder

MANAGEMENT OF ERECTILE DYSFUNCTION

± ECT**/rTMS

Combination MS and AAP: MS: Lamotrigine,  valporate † , lithium AAP: Olanzapine,  quetiapine, lurasidone, cariprazine, OFC, lumateperone Add on MS or AAP + antidepressant (short-term) AAP=atypical antipsychotic AP=antipsychotic ECT=electroconvulsive therapy MS=mood s

ALGORITHM 2. TREATMENT OF ACUTE DEPRESSIVE EPISODE

ACUTE DEPRESSIVE EPISODE STEP 1* Monotherapy AAP: Olanzapine Quetiapine Lurasidone Cariprazine OFC Lumateperone No response in 2 weeks or intolerable AEs STEP 2 MS + AAP  MS + MS   No response in 2 weeks or intolerable AEs STEP 3 Replace one or both agents with other age

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Switch: MS to AAP or other MS AAP to MS or other AAP

Monotherapy MS: Lamotrigine  Valproate †  Lithium    *Consider optimisation and assessment of compliance if on treatment † valproate - Safety concerns present, refer to Appendix 5 & 9 in CPG

**ECT should be considered in the following conditions: rapid definitive response is required risk of other alternatives outweighs risk of ECT previous good response to ECT patient’s preference treatment-resistant cases
Psychosocial Intervention ± Psychotherapy

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