title: Bipolar depression: best practices for the outpatient.
abstract: Although certain aspects of bipolar disorder are well understood, there is a need for more information concerning management of acute bipolar depression, the effect of comorbid conditions, and long-term management of bipolar disorder. The outpatient presenting with bipolar disorder often presents with many of the key problems related to the long-term course of the disorder, including misdiagnosis and treatment non-adherence. Depressive symptoms are also prevalent during the course of bipolar disorder, with studies finding that depression can cause a low-grade "darkness" that longitudinally affects outpatients with bipolar disorder. These variable and persistent depressive symptoms may cause severe functional impairment and increased suicidality. Pharmacologic treatment of bipolar disorder typically includes anti-manic and mood-stabilizing medication. Although some studies find antidepressants have some positive effect, researchers have found that antidepressants, including selective serotonin reuptake inhibitors, when used as monotherapy or in conjunction with mood stabilizers, have little benefit for the treatment of bipolar disorder and may increase the likelihood of a switch into mania, hypomania, or mixed episodes. For long-term outpatient treatment, lamotrigine and lithium are proven to be highly effective. However, clinicians should also stress psychosocial treatment approaches, such as cognitive-behavioral therapy, as a principle of chronic disease management for long-term outpatients. Data on pharmacotherapy and psychosocial treatments are emerging, and clinicians should integrate these two treatment options into the standard of care. This expert roundtable supplement focuses on the treatment and management of the bipolar outpatient at risk for a depressive relapse as well as patients experiencing both acute and long-term symptoms of the disorder. Two case studies are presented to elucidate the best practices for the varying clinical states of bipolar disorder.
authors.affiliation: Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Keck
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.forename: Richard C
authors.initials: RC
authors.lastname: Shelton
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000145:classification / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000139:chemically induced / Q000188:drug therapy*; D004351:Drug Resistance; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D010507:Periodicity
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents