Treatment options for bipolar depression

Abstract

Bipolar disorder is often misdiagnosed as major depressive disorder because of the high frequency of depressive symptomatology in many patients with bipolar disorder. Depressive episodes that are resistant to treatment may also be associated with a worse course of illness in bipolar disorder, but we do not yet understand all the factors in the connection between bipolar disorder and depression. The data on the effectiveness of antidepressants in the treatment of depression in bipolar disorder vary greatly, and there have been few prospective, randomized studies on the subject. From the data so far, the rates of induction of mania for selective serotonin reuptake inhibitors and lamotrigine seem similar to those seen with placebo. The optimal length of time to continue antidepressant treatment in patients with bipolar disorder has not yet been determined; however, research tends to indicate that a longer term of treatment (6 months or more) may aid in the prevention of relapse. Newer U.S. Food and Drug Administration-approved treatments for depression in bipolar disorder include a combination of olanzapine and fluoxetine, which is used for depressive episodes in bipolar disorder, and lamotrigine, which is used for maintenance treatment of bipolar I disorder. Psychoeducation has also been examined as a possible treatment for depression in bipolar disorder, and a study has shown that patients receiving psychoeducation plus medication may have a lower rate of relapse than patients who receive medication alone.