title: An update on the treatment of bipolar depression.
abstract: 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.
authors.affiliation: Pôle Universitaire de Psychiatrie-Solaris, Hôpital Ste Marguerite, 13274 Marseille Cedex 9, France. jazorin@ap-hm.fr
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Azorin
authors.forename: Arthur
authors.initials: A
authors.lastname: Kaladjian
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D003987:Dibenzothiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005473:Fluoxetine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D015201:Meta-Analysis as Topic; D000069348:Quetiapine Fumarate; D016032:Randomized Controlled Trials as Topic
chemical_list: 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