The Texas Implementation of Medication Algorithms: Update to the Algorithms for Treatment of Bipolar I Disorder
J Clin Psychiatry 2005;66(7):870-886
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: A panel consisting of academic
psychiatrists and pharmacist administrators of the Texas
Department of State Health Services (formerly Texas Department of
Mental Health and Mental Retardation), community mental health
physicians, advocates, and consumers met in May 2004 to review
new evidence in the pharmacologic treatment of bipolar I disorder
(BDI). The goal of the consensus conference was to update and
revise the current treatment algorithm for BDI as part of the
Texas Implementation of Medication Algorithms, a statewide
quality assurance program for the treatment of major psychiatric
illness. The guidelines for evaluating possible medications, the
criteria for selection and ranking, and the updated algorithms
Method: Principles from previous consensus
conferences were reviewed and amended. Medication algorithms for
the acute treatment of hypomanic/manic or mixed and depressive
episodes in BDI were developed after examining recent efficacy
and safety and tolerability data. Recommendations for maintenance
treatments were developed.
Results: The panel updated the 2 primary
algorithms (hypomanic/manic/mixed and depressive) based on
clinical evidence for efficacy, tolerability, and safety
developed since 2000. Expert consensus was utilized where
clinical evidence was limited. Prevention of new episodes or
prophylaxis treatment recommendations were developed based on
recent data from longer-term trials. Maintenance recommendations
are provided as levels versus a specified staged algorithm, as
for acute treatment, due to the relatively limited database to
Conclusions: These algorithms for the treatment
of BDI represent the recommendations based on the most recent
evidence available. These recommendations are meant to provide a
framework for clinical decision making, not to replace clinical
judgment. As with any algorithm, treatment practices will evolve
beyond the recommendations of this consensus conference as new
evidence and additional medications become available.