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Psychopharmacology Algorithm Project at the Harvard South Shore Psychiatry Program

Bipolar Depression Algorithm, 2010 Revision

David Osser, MD, Arash Ansari, MD, Robert Patterson, MD VA Boston Healthcare System and Harvard Medical School, Brockton, Massachusetts USA

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Go to www.psychopharm.mobi from any device with internet access.

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POSTER 99 Evidence2010 BMA House, London. November 1-2, 2010

Background: The authors have been creating software since 1993 that provides consultation to clinicians on how to choose evidence-supported pharmacotherapy for psychiatric patients. For this revision of the bipolar depression algorithm, the authors started a new domain, psychopharm.mobi. The intent is to display the algorithms in condensed format suitable for mobile phone and personal digital assistant devices.

Methods: PubMed searches were conducted to

find all relevant studies since the last published version (1999). Boolian (AND) searches combined identified medications with the keywords “bipolar depression.” 248 references were found to be most pertinent. The draft was peer-reviewed by 5 experts, revised, and published in the Harvard Review of Psychiatry 2010;18:36-55. The authors worked from this publication to create the mobile internet version to be displayed on this poster, using Joomla as the browser.

Algorithm Summary: After diagnosis, the physician should assess whether there is an urgent indication for electroconvulsive therapy. If ECT is

not indicated, and the patient has psychotic symptoms, then an antipsychotic should be part of the medication regimen. Next, if the patient is not currently treated with mood stabilizers, there is a slight preference for lithium. If lithium is not effective or tolerated, treatment with quetiapine or lamotrigine should be initiated; first one, then the other. If the patient is currently taking other mood stabilizers, their dosage should be optimized first, and then the clinician should consider adding or switching to lithium, quetiapine, or lamotrigine. Next, if the patient is not a rapid cycler (4 or more mood episodes per year), an antidepressant can be added. Rapid-cycling patients may require

combinations of mood stabilizers. Finally, ECT could be reconsidered, as well as other psychopharmacological options, for the treatment of refractory patients.

Conclusion: Evidence-based advice for the treatment of very complex patients can be communicated rapidly on smart phones/PDAs. The information is easily updated.

Competing interests: None. Acknowledgement: Ana Ticlea, MD

helped design this poster. Corresponding author: dno@theworld.com

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