Korean Medication Algorithm Project for Bipolar Disorder 2026: Comparisons with Other Treatment Guidelines

The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2026 (KMAP-BP 2026) with other recently published guidelines for treating bipolar disorder.We reviewed five previously published global treatment guidelines and compared treatment recommendations of the KMAP-BP 2026.For initial treatment of acute mania, there were no substantial differences across treatment guidelines; all guidelines recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy, or a combination of MS with AAP as first-line strategies.Aripiprazole, quetiapine, olanzapine, and risperidone were recommended as first-line AAPs for the treatment of mania, a trend consistent across all guidelines, including the KMAP-BP 2026.However, the KMAP-BP 2026, differing from other guidelines, recommended the combination of MS and AAP as the first-line treatment strategy even for manic episodes without psychotic features.For depressive episodes, the KMAP-BP 2026 recommend lurasidone, newly available in Korea, as a first-line AAP.While lithium and lamotrigine remained preferred options for depressive episodes, valproate was recommended as a second-line treatment in most guidelines, including the KMAP-BP 2026, although RANZCP 2020 listed it among first-line monotherapy options.The recommendation of bupropion as a first-line antidepressant for depressive episodes is a characteristic feature of KMAP-BP 2026.In maintenance treatment, the KMAP-BP 2026 recommended the use of AAPs, such as aripiprazole, either as monotherapy or in combination with MS, which was also consistent with recommendations in other guidelines, although some guidelines listed olanzapine as a second-line maintenance option due to its metabolic side effects.Overall, KMAP-BP 2026 guidelines remained broadly consistent with international treatment guidelines while reflecting updated clinical evidence and Korean clinical practice patterns, with a notably increased preference for AAPs across all phases and episodes of bipolar disorder.