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A Journal on Psychiatry, Psychology and Psychopharmacology
Official Journal of the Italian Society of Social Psychiatry
Indexed/Abstracted in: EMBASE, e-psyche, PsycINFO, Scopus, Emerging Sources Citation Index
Minerva Psichiatrica 2003 June;44(2):97-108
The pharmacological treatment of bipolar depression
The treatment of bipolar depression is a relatively understudied area in clinical psychiatry. The depressed phase of bipolar disorder seems to be less responsive to standard treatment than the manic phase. In this review the studies on the pharmachological treatment of bipolar depression and the guidelines at mild and severe bipolar depression are analyzed. Since antidepressants are associated with induction of mania, hypomania or acceleration of cycling, monotherapy with unimodal antidepressant agents is generally avoided. Bupropion and the selective serotonin reuptake inhibitors may be associated with less risk of inducing hypomania, mania, and rapid cycling compared with tricyclic antidepressants. The use of standard antidepressants along with a mood stabilizer decreases the risk of switching. Antidepressants are frequently used in combination with lithium owing to evidence of synergism or potentiation in both unipolar and bipolar depressed patients. Lithium has an estimated overall complete or partial response rate higher in bipolar depressed patients than in unipolar patients. Lithium is a relatively effective treatment for acute bipolar depression and provides moderately effective protection against bipolar depressive recurrences. Other mood stabilizers have demonstrated preliminary efficacy. Carbamazepine and valproate possess both antimanic and antidepressant efficacy. Gabapentine and lamotrigine have demonstrated preliminary efficacy in bipolar depression.