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.

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    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.
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