Update of TIMA Guideline for Bipolar I Disorder

Table 1.

Levels	Treatment Options
Level I	Patients with frequent, recent, or severe mania: Lithium or valproate
	Patients without frequent, recent, or severe mania: Lithium, valproate, or lamotrigine
	Alternative: Olanzapine*
Level II	Aripiprazole^†
Level III	Carbamazepine or clozapine*
Level IV	Quetiapine,^† risperidone,^† or ziprasidone^†
Level V	Typical antipsychotics,* oxcarbazepine,^† ECT

Maintenance Treatment: Most Recent Episode Hypomanic/Manic/Mixed

*Safety issues warrant careful consideration of this option for potential long-term use.
^†Relatively limited information is currently available on this agent in long-term use.
From Suppes T, et al. J Clin Psychiatry. 2005;66:870-886.^[1] Copyright 2005, Physicians Postgraduate Press. Republished by permission.

Table 2.

Levels	Treatment Options
Level I	Patients with recent and/or severe history of mania: Lamotrigine combined with an antimanic agent
Level I	All other patients: Lamotrigine monotherapy
Level II	Lithium
Level III	Combination of an antimanic and antidepressant that has been effective in the past, including olanzapine-fluoxetine combination*
Level IV	Valproate, carbamazepine, aripiprazole,^† clozapine,* olanzapine,* quetiapine,^† risperidone,^† ziprasidone^†
Level V	Typical antipsychotics,* oxcarbazepine,^† ECT

Maintenance Treatment: Most Recent Episode Depression

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Overview

Many new compounds for the treatment of bipolar I disorder (BDI) have become available since the last algorithm update of 2000, and further research has been completed and published for existing compounds. The purpose of the 2004 Consensus Conference was to review the Texas Implementation Medication Algorithms (TIMA) for patients with bipolar I disorder (BDI) and to update the algorithm with new evidence-based recommendations.^[1] The panel that presented the conference consisted of national experts in the treatment of bipolar disorder, pharmacists, representatives from the state system, and consumers. Treatment options were reviewed for hypomania/mania, mixed symptoms, depression, and maintenance treatments, and were evaluated on the basis of an assessment of efficacy, safety issues, and adverse effects in the treatment of BDI. When possible, evaluations were based on evidence from well-controlled studies, and each study was judged on its own merits.

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Guiding Principles of The Texas Implementation of Medication Algorithms (TIMA)

References

Table 1.

Table 2.

Update of the Texas Implementation of Medication Algorithms for Bipolar I Disorder

Overview

Table of Contents

Table 1.

Table 2.

References

Faculty and Disclosures

Update of the Texas Implementation of Medication Algorithms for Bipolar I Disorder

Overview

Table of Contents