title: The use of antidepressants in bipolar disorder patients with depression.
abstract: BACKGROUND
  The proportion of time that bipolar patients experience depressive symptoms and clinical states, with associated psychosocial impairment and elevated risk of suicide, is significantly greater than the time spent in manic/hypomanic forms of bipolar disorders. Yet, manic states and symptoms have been the focus and interest of most clinical research over the past quarter century. Not a single antidepressant approved for treatment of major depressive disorder, as monotherapy, has received regulatory approval for treatment of bipolar depression as monotherapy, despite their common use in bipolar depression.
  
  
  METHODS
  We reviewed randomized studies, particularly ones initially intended for registration purposes, and systematic treatment guidelines, in development of this guide to treatment decision and implementation of interventions for depression in bipolar disorders.
  
  
  CONCLUSIONS
  The Expert Opinion section emphasizes strategies, not individual agents. The efficacious performance of mood stabilizers and second-generation antipsychotics as a component of the strategy is strongly supported by published studies. However, this section relies largely on secondary publications and our combined clinical experience, as few randomized, blinded studies have had, as their focus, the comparison of combined regimens for depression. This article summarizes the design features and results of studies dealing with depressive features and intervention strategies for bipolar disorders. The emphasis of the recommendations is on pragmatic treatment decisions that clinicians can make to enhance the probability of both short and long term benefits for patients.
authors.affiliation: a Clinical Professor of Psychiatry and Pharmacology , University of Texas Health Science Center at San Antonio , San Antonio , TX , USA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bowden
authors.affiliation: b Professor and Chairman for Department of Psychiatry, Paul L. Foster School of Medicine , Texas Tech University Health Sciences Center , El Paso , TX , USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Singh
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013405:Suicide
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: bipolar; combination regimen; depression; treatment