[Guidelines for the biological treatment of bipolar depression].
Numerous guidelines for the treatment of bipolar disorder have been published in the recent years. A review focusing on recent international and French guidelines the last 5 years on the management of bipolar depression was conducted. The comparison of guidelines showed differences in the choice of initial treatment: monotherapy (in first line: quetiapine and lamotrigine) or polypharmacotherapy (in first line: combination olanzapine/fluoxetine). All guidelines recommend in patients with inadequate response a therapeutic strategy in two steps. An initial clinical stage seeking the causes of poor therapeutic response and a second therapeutic stage trying to optimize the current treatment, to change treatment or to consider a co-therapy. In first line, the prophylactic drugs recommended are: lithium, valproate, quetiapine; olanzapine, risperidone (and long-acting formulation) and aripiprazole mainly for the prevention of manic episodes; lamotrigine limited to prevention of depressive episodes. The duration of treatment before patient reassessment and that of maintenance therapy are not consensual. The development of second-generation antipsychotics in bipolar depression is an interesting development for our therapeutic armamentarium and has been incorporated in recent guidelines.
CHU Clermont-Ferrand, BP 69, Clermont-Ferrand cedex 01, France. lsamalin@chu-clermontferrand.fr
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Charpeaud
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Guillaume
D000339:Affect / Q000187:drug effects; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D008134:Long-Term Care; D017410:Practice Guidelines as Topic
D018692:Antimanic Agents