7 - Pharmacologic and somatic treatments for bipolar depression

Summary

Studies including patients with depression in the course of bipolar disorder I or II indicate lithium's effectiveness in the treatment and prevention of bipolar depression. A handful of studies have focused on the use of antidepressants as maintenance treatment for bipolar patients. Long-standing concerns that antidepressant treatment of bipolar depression may induce a switch to mania, an onset of rapid cycling, or treatment resistance. This chapter lists out various antidepressants that include quetiapine, lamotrigine, olanzapine/fluoxetine, aripiprazole, ziprasidone, risperidone, carbamazepine and valproate. The other treatments for bipolar depression include electroconvulsive therapy, deep brain stimulation and transcranial magnetic stimulation. As a secondary strategy, based on existing data, it seems reasonable to use antidepressants in combination with a mood stabilizer, with attention paid to possible emergence of manic/hypomanic symptoms. Despite widespread usage, the efficacy of lamotrigine for either acute or maintenance treatment of bipolar depression remains in question.