Bipolar depression: treatment options.
OBJECTIVE
To review studies on treatments for bipolar depression and make recommendations for practising clinicians treating patients with bipolar depression.


METHODS
Studies that examined various treatments for bipolar depression were evaluated and rated for evidence of efficacy using Periodic Health Examination criteria. The rating for classification of recommendation for an intervention was made taking both the efficacy and the side effects into consideration.


RESULTS
Mood stabilizers, cyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and electroconvulsive therapy (ECT) are all effective in treating bipolar depression. Almost all antidepressant treatments with the exception of mood stabilizers have been reported to induce a manic-hypomanic switch and rapid cycling.


CONCLUSIONS
Mood stabilizers, lithium in particular, are recommended as the first-line treatment. Addition of a second mood stabilizer or a cyclic antidepressant would be an appropriate next step. Newer agents such as lamotrigine offer considerable promise in treating bipolar depressed patients.
Yatham
L N
LN
Department of Psychiatry, University of British Columbia, Vancouver. yatham@unixg.ubc.ca
Kusumakar
V
V
Parikh
S V
SV
Haslam
D R
DR
Matte
R
R
Sharma
V
V
Kennedy
S
S
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy; D006801:Humans; D016896:Treatment Outcome
D000928:Antidepressive Agents