The Canadian Network for Mood and Anxiety Treatments guidelines for the treatment of bipolar disorder outline a step-wise approach to helping patients with acute mania, 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 monotherapies for acute mania: lithium, quetiapine, valproate, asenapine, aripiprazole, paliperidone, risperidone, cariprazine.
- Hierarchy of first-line combination therapies for acute mania: lithium or valproate with quetiapine, aripiprazole, risperidone, or asenapine.
- Hierarchy of second-line combination therapies for acute mania: olanzapine, carbamazepine, lithium or valproate with olanzapine, lithium with valproate, ziprasidone, haloperidol, electroconvulsive therapy.