The Canadian Network for Mood and Anxiety Treatments guidelines for the treatment of bipolar disorder outline a step-wise approach to helping patients with bipolar depression, including detailing which pharmacotherapies should be attempted as a first-line therapy, before moving on to second- and third-line therapies.1
- Hierarchy of first-line treatments for acute bipolar depression: quetiapine, lurasidone with lithium or valproate, lithium, lamotrigine, lurasidone, adjunctive lamotrigine.
- Hierarchy of second-line treatments for acute bipolar depression: valproate, a selective-serotonin reuptake inhibitor (SSRI) or adjunctive bupropion, electroconvulsive therapy, cariprazine, olanzapine–fluoxetine combination.