Expert Consultations: Real-World Answers

An Update on Bipolar Mania Algorithm – Interview

Published on December 1, 2024 Certification expiration date: December 1, 2027

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Helen Tellegen

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Highlights

Depression commonly follows mania episodes. When choosing antimanic agents, prioritize medications that can prevent post-manic depression and serve as maintenance therapy.
Quetiapine is preferred for mixed mania due to efficacy in acute depression and maintenance. Target dose is 600-800mg, with potential rapid titration.
For acute agitation, IM haloperidol plus promethazine has strongest evidence. IM olanzapine is a reasonable alternative with 10mg for men, 5-7mg for women.

Mixed Mania Treatment Algorithm

Helen Tellegen, PMHNP: I'd like to start with mania with mixed features. The first-line option is a second-generation antipsychotic with quetiapine or cariprazine being the strongest contenders. Why would you choose these two agents over other second-generation antipsychotics in mixed mania?

David Osser, MD: The algorithm indicates a slight preference for quetiapine,

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Learning Objectives:

After completing this activity, the learner will be able to:

Select appropriate antimanic agents based on their efficacy in preventing post-manic depression and serving as maintenance therapy, with emphasis on prioritizing medications that demonstrate effectiveness across multiple phases of bipolar disorder.
Evaluate and implement first and second-line treatment options for both classic and mixed mania, including the evidence-based use of quetiapine for mixed mania and lithium for classic mania.
Apply evidence-based strategies for managing acute agitation in mania.

Original Release Date: December 1, 2024

Expiration Date: December 1, 2027

Expert: David Osser, M.D.

Medical Editors: Helen Tellegen, M.D., Flavio Guzmán, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credits.
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Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

David Osser, M.D.