Clinical inquiries: what drugs are best for bipolar depression?
Antidepressants and lamotrigine are effective. Atypical antipsychotics, lithium, and anticonvulsants also may help. Antidepressants, including tricyclics and selective serotonin reuptake inhibitors (SSRIs), are useful adjuncts in short-term treatment of bipolar depression and have low rates of inducing mania (strength of recommendation [SOR]: 1 systematic review and randomized controlled trials [RCTs]). Lamotrigine is beneficial for both acute treatment of bipolar depression and prevention of recurrent episodes (SOR: 1 systematic review and 1 RCT). Some atypical antipsychotics alone (SOR: 2 RCTs) or in combination with antidepressants (SOR: 1 multicenter RCT) effectively treat acute bipolar depression. Lithium and anticonvulsants such as valproate also may be useful (SOR: limited number of studies with small sample sizes).
Ukaegbu
Chibuzo
C
Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
Banks
J Burton
JB
Carter
Nakia J
NJ
Goldman
Larry S
LS
D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D006801:Humans; D000077213:Lamotrigine; D016896:Treatment Outcome; D014227:Triazines / Q000627:therapeutic use*
D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D014227:Triazines; D000077213:Lamotrigine