An update on the treatment of bipolar depression.
BACKGROUND
Although depression accounts for a large part of the burden associated with bipolar disorder, its drug treatment has been under-studied.


OBJECTIVE
To provide the best available evidence supporting the pharmacotherapy of bipolar depression.


METHODS
A systematic review was conducted, focusing on randomized, controlled trials (RCTs) and meta-analyses.


CONCLUSIONS
Despite FDA approval of both the olanzapine-fluoxetine combination and quetiapine for the treatment of acute bipolar depression, independent RCTs (i.e., not trials conducted 'under the umbrella' of a drug company) have not found any drug to have antidepressant effects similar to those seen in unipolar depression. A practice-based suggestion, valuable for both short- and long-term treatment, might be to have a background of mood stabilizers and to add drugs, following one of several treatment options, trusting to find a drug with a degree of effectiveness by trial and error. The list of drugs that could be used would include all the current antidepressants, the olanzapine-fluoxetine combination and probably quetiapine too. Special features and situations might also influence treatment options.
Azorin
Jean-Michel
JM
Pôle Universitaire de Psychiatrie-Solaris, Hôpital Ste Marguerite, 13274 Marseille Cedex 9, France. jazorin@ap-hm.fr
Kaladjian
Arthur
A
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D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D004338:Drug Combinations; C492572:olanzapine-fluoxetine combination; D005473:Fluoxetine; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate