The Texas implementation of medication algorithms: update to the algorithms for treatment of bipolar I disorder

J Clin Psychiatry. 2005 Jul;66(7):870-86. doi: 10.4088/jcp.v66n0710.


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 are described.

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 inform treatment.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms*
  • Antipsychotic Agents / therapeutic use
  • Bipolar Disorder / drug therapy*
  • Bipolar Disorder / prevention & control
  • Clozapine / therapeutic use
  • Consensus
  • Decision Trees
  • Drug Therapy, Combination
  • Evidence-Based Medicine / statistics & numerical data
  • Humans
  • Lithium / therapeutic use
  • Patient Care Planning
  • Practice Guidelines as Topic / standards*
  • Psychotropic Drugs / therapeutic use
  • Quality Assurance, Health Care / methods
  • Serotonin Uptake Inhibitors / therapeutic use
  • Texas


  • Antipsychotic Agents
  • Psychotropic Drugs
  • Serotonin Uptake Inhibitors
  • Lithium
  • Clozapine