Treatment of acute bipolar depression: A review of the literature

Department of Psychiatry, University of British Columbia, Vancouver.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 12/1995; 40(9):533-44.
Source: PubMed


Our goal was to ascertain the efficacy of various antidepressant treatments for acute bipolar depression.
English articles that reported on the efficacy of antidepressant treatments in bipolar depression were located by computerized Medline and manual search. These studies were systematically reviewed and response rates for each treatment were computed.
The available data suggest that mood stabilizers, MAOIs, cyclic antidepressants, and ECT are all effective in treating bipolar depression. All antidepressant treatments with the exception of mood stabilizers have been reported to induce a manic/hypomanic switch.
It is recommended that mood stabilizers may be the first step of treatment, followed by the addition of an antidepressant, especially a cyclic antidepressant. The specific symptoms profile of individual patients, such as anergic or psychotic features, may indicate more specific treatment options. ECT is an important measure for those who are pharmacotherapy-resistant or psychotic.

3 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Depressive symptoms in bipolar disorder generally predominate over hypomanic/manic symptoms and can be more difficult to treat. As a result, they are responsible for much of the suffering, morbidity, and mortality from this illness. However, there are many fewer randomized, controlled trials of treatments for bipolar depression than for unipolar depression, and this has led to much controversy and confusion regarding the best treatment strategies. A number of expert consensus panels have issued guidelines, taking into account the sum of the past and present literature, with treatment recommendations. This article examines historically relevant and recent randomized, controlled trials of acute treatments for bipolar depression in the context of the latest US expert consensus panel guidelines.
    Current Psychosis and Therapeutics Reports 12/2006; 4(4):151-158. DOI:10.1007/BF02629389
  • [Show abstract] [Hide abstract]
    ABSTRACT: We sought to determine whether depressive and mixed/cycling episodes were as responsive to standardized pharmacotherapeutic interventions as were manic episodes in bipolar 1 patients. As part of the Maintenance Therapies in Bipolar Disorder (MH29618, E. Frank, PI) study, forty-two acutely ill bipolar 1 patients who had been randomly assigned to one of two preliminary phase non-pharmacologic treatment strategies (interpersonal and social rhythm therapy [IPSRT] or a standard medication clinic approach) were treated according to a standardized pharmacotherapeutic protocol. Symptom severity was measured weekly with the Hamilton Depression Rating Scale and the Bech-Rafaelsen Mania Scale in order to assess symptomatic remission. Survival analysis with the proportional hazards model was performed on time to remission. Manic patients were significantly more likely to achieve clinical remission than the depressed patients (100 vs. 59%) and did so significantly more rapidly. The difference in proportion remitting and time to remission between the depressed and mixed/cycling groups was not statistically significant. No significant effect for non-pharmacologic treatment assignment was found. These results point to the need to develop more effective treatments for bipolar depression. They also suggest that psychotherapy has a limited impact in the acute phase treatment of bipolar episodes.
    Depression and Anxiety 02/1997; 5(2):73-83. DOI:10.1002/(SICI)1520-6394(1997)5:2<73::AID-DA3>3.0.CO;2-6 · 4.41 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To summarize the quality of evidence for the efficacy of different biological treatments in mania, mixed state, and rapid cycling and to propose guidelines for treatment of these conditions. Articles published on treatment of acute mania, mixed states, and rapid cycling were reviewed and rated for quality of evidence using Periodic Health Examination guidelines. Lithium and divalproex sodium are effective in classical pure mania, whereas divalproex sodium and carbamazepine are likely more effective in mixed states. Divalproex sodium is likely more efficacious than carbamazepine and lithium when the mania is part of a rapid-cycling course. Typical neuroleptics are efficacious in acute mania, particularly in the presence of marked psychotic symptoms. Atypical neuroleptics can be useful in refractory mania. Some benzodiazepines do have antimanic effects, but they are increasingly being shown to have usefulness as adjuncts to mood stabilizers or neuroleptics rather than as primary antimanic agents. Electroconvulsive therapy (ECT) is an efficacious and broad-spectrum treatment. Mania can present with or without mood-congruent or mood-incongruent psychotic features and as part of a rapid-cycling or nonrapid-cycling course. Mixed state is a common presentation in an acutely manic patient. The accurate assessment of these issues can serve as a guide in determining treatment options and choices.
    Canadian journal of psychiatry. Revue canadienne de psychiatrie 09/1997; 42 Suppl 2:79S-86S. · 2.55 Impact Factor
Show more