Pharmacotherapy for the treatment of acute bipolar II depression: current evidence.
OBJECTIVE
Bipolar II disorder is a common, recurrent, and disabling psychiatric illness, and yet little is known about how best to treat it. The pressing clinical need for evidence-based approaches to the treatment of bipolar II disorder, coupled with recent publication of pertinent studies, calls for an updated review of this literature. This review focuses on a critical examination of the evidence supporting the efficacy of treatments for acute depressive episodes in bipolar II disorder.


METHODS
A MEDLINE (via Ovid) search of journals, covering the period from January 1950 to January 2009, was performed to identify relevant studies. Keywords used were bipolar II disorder, bipolar disorder, bipolar depression, and pharmacotherapy. Studies were further limited to those that were in adult samples, published in peer-reviewed journals, and written in English.


METHODS
We examined all randomized trials evaluating the use of pharmacotherapy in the treatment of acute bipolar II depression. Studies with mixed samples of bipolar I and II or bipolar II and unipolar depression were examined as well. Twenty-one randomized trials were identified and reviewed.


METHODS
Therapeutic agents were rated according to the quality of evidence supporting their efficacy as treatments for bipolar II depression.


RESULTS
Ninety percent of relevant trials were published after 2005. Quetiapine was judged as having compelling evidence supporting its efficacy. Lithium, antidepressants, and pramipexole were judged as having preliminary support for efficacy. Lamotrigine was considered to have mixed support.


CONCLUSIONS
Although progress has been made, further research on bipolar II depression is warranted.
Swartz
Holly A
HA
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. swartzha@upmc.edu
Thase
Michael E
ME
D000208:Acute Disease; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D052160:Benzothiazoles / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D003987:Dibenzothiazepines / Q000627:therapeutic use; D006801:Humans; D000077213:Lamotrigine; D018020:Lithium Compounds / Q000627:therapeutic use; D000077408:Modafinil; D000077487:Pramipexole; D000069348:Quetiapine Fumarate; D014227:Triazines / Q000627:therapeutic use
D000928:Antidepressive Agents; D018692:Antimanic Agents; D001559:Benzhydryl Compounds; D052160:Benzothiazoles; D003987:Dibenzothiazepines; D018020:Lithium Compounds; D014227:Triazines; D000069348:Quetiapine Fumarate; D000077487:Pramipexole; D000077408:Modafinil; D000077213:Lamotrigine
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