Treatment options for acute depression in bipolar disorder
Bipolar Disorders, 04/19/2012
Bauer M et al. – Treatment decisions in bipolar depression involve a range of different pharmacological and non–pharmacological options. Monitoring potential unwanted effects and the appropriateness of treatment can help to effectively balance benefits and risks in individual situations.Methods
- The evidence is largely based on a systematic literature search and appraisal that was part of the development of the German Guideline for Bipolar Disorders.
- All relevant randomized controlled trials were critically evaluated.
- Overall, the number of suitably controlled studies for the treatment of bipolar depression is relatively low.
- There are two common scenarios.
- Scenario A, if a patient with bipolar depression is currently not being treated with a mood-stabilizing agent (de novo depression, first or subsequent episode), then quetiapine or olanzapine are options, or alternatively, carbamazepine and lamotrigine can be considered.
- Antidepressants are an option for short-term use, but whether they are best administered as monotherapy or in combination with mood-stabilizing agents is still controversial.
- In practice, most clinicians use antidepressants in combination with an antimanic agent.
- Scenario B, if a patient is already being treated optimally with a mood-stabilizing agent (good adherence and appropriate dose) such as lithium, lamotrigine is an option.
- There is no evidence for additional benefit from antidepressants where a patient is already being treated with a mood stabilizer; however, in practice an antidepressant is often trialled.
- Efficient psychotherapy is an important part of the treatment regimen and should span all phases of the illness.