title: Pharmacotherapy of bipolar depression: an update.
abstract: Bipolar affective disorder is a virulent illness with high rates of recurrence, disability, social impairment, and suicide. Although the manic or hypomanic episodes define the disorder, the depressions are more numerous and less responsive to treatment. As the initial depressive episodes are commonly misdiagnosed, initiation of therapy with mood stabilizers is often delayed, increasing the likelihood of treatment-emergent affective switches on antidepressant monotherapy. The empirical basis for selecting treatments for people with bipolar depression is weak, and only the combination of olanzapine and fluoxetine has received US Food and Drug Administration (FDA) approval. Conventional mood stabilizers are preferred for first-line therapies, although atypical antipsychotics are increasingly used, and FDA approval of quetiapine is pending. Antidepressants--particularly selective serotonin reuptake inhibitors and bupropion--are indicated when mood stabilizers are ineffective and for "breakthrough" depressions.
authors.affiliation: University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213-2593, USA. thaseme@upmc.edu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D006801:Humans; D017410:Practice Guidelines as Topic; D055502:Secondary Prevention
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents