Korean Medication Algorithm Project for Bipolar Disorder 2026, Sixth Revision: An Executive Summary

Objective: The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) provides expert consensus-based pharmacotherapy recommendations tailored to Korean clinical practice and healthcare settings.This sixth revision, the KMAP-BP 2026, was developed to incorporate recent evidence and evolving expert opinion since the previous edition.Methods: A structured questionnaire was distributed to a review committee of psychiatric experts across Korea.Survey responses were analyzed and subsequently refined through expert hearings to establish consensus recommendations across the major phases of bipolar disorder.Results: For acute mania, mood stabilizer (MS) + atypical antipsychotics (AAP) combination was designated as the treatment of choice (TOC) when psychotic features were present, while MS + AAP, MS monotherapy, or AAP monotherapy were all first-line options in their absence.For depressive episodes, MS, lamotrigine (LMT), or AAP monotherapy and combinations including MS + AAP, AAP + LMT, and MS + LMT were recommended as first-line strategies for mildto-moderate severity; notably, AAP monotherapy was elevated to first-line for severe depression, and MS + AAP was the TOC when psychotic features were present.For mixed features, MS + AAP was the TOC for manic-predominant and mixed features without predominance, while depressive-predominant mixed features allowed for a broader first-line armamentarium.Conclusion: The KMAP-BP 2026 reflects both the evolving landscape of psychiatric practice in Korea and the accumulation of recent pharmacotherapy evidence, reflecting both continuity and refinement of prior recommendations.These updated recommendations are intended to serve as a practical, evidence-informed resource for clinicians navigating the complexities of bipolar disorder management.