Treatment of bipolar depression

The depressive episode appears to be the more refractory and difficult-to-treat pole of bipolar disorder. Bipolar depression is usually treated with a combination of a mood stabilizer and an antidepressant [1]. Although the antidepressant efficacy of most mood stabilizers has so far not been proven in a satisfactory way, it seems sensible that a mood stabilizer should at least accompany treatment in any phase of the illness. The role of antidepressants, however, has been disputed for a long time. A potential switch induced by an antidepressant was balanced against the negative impact of insufficiently treated depression, including chronification and suicidality. Despite lacking unambiguous scientific evidence SSRI’s and bupropion appear to be both safe and efficacious in treating bipolar depression. Additionally, some atypical antipsychotics exhibit intrinsic antidepressive properties which may be useful as an augmentative treatment approach.

1. Grunze, H. et al. World J Biol Psychiatry 3 (2002);115–124