Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-24T02:42:51.605Z Has data issue: false hasContentIssue false
  • English
  • Français

Treating bipolar depression – antidepressants and alternatives: a critical review of the literature

Published online by Cambridge University Press:  24 June 2014

Antonio Tundo ,
Paola Cavalieri ,
Serena Navari  and
Fulvia Marchetti
Antonio Tundo*
Affiliation:
Institute of Psychopathology, Rome, Italy
Paola Cavalieri
Affiliation:
Institute of Psychopathology, Rome, Italy
Serena Navari
Affiliation:
Institute of Psychopathology, Rome, Italy Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College, London, UK
Fulvia Marchetti
Affiliation:
Institute of Psychopathology, Rome, Italy
*
Antonio Tundo, Institute of Psychopathology, Via Girolamo da Carpi, 1, Rome 00196, Italy. Tel: +39 06 3610955; Fax: +39 06 36002828; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Extract

Objective: Although depressive symptoms are preponderant in the course of bipolar (BP) disorders, the treatment of BP depression remains a controversial issue with different clinical approaches available. This review addresses the issues of whether antidepressants (ADs) are effective in treating acute and long-term BP depression, risks linked to ADs and what alternatives to ADs are available.

Methods: We searched the MEDLINE databases using the following syntax: [bipolar depression AND unipolar depression AND (antidepressants OR anticonvulsants OR lithium OR antipsychotics OR dopamine-agonists OR psychoeducation OR psychotherapy OR electroconvulsive therapy OR transcranial magnetic stimulation)]. The search included studies published up to 31 May 2009 and conducted on adults.

Results: In the acute treatment of BP depression ADs are effective with no differences among drug classes. However, neither the switch into (hypo)mania induction rate nor the suicide risk linked to AD use are definitely established. The effectiveness of long-term AD use is limited to highly selected samples of patients with positive acute response. The risk of long-term ADs causing cycle acceleration and rapid cycling induction concerns a subpopulation of patients. Valid alternatives to ADs in treating acute BP depression are quetiapine, an olanzapine–fluoxetine combination, and electroconvulsive therapy for more severe patients. Lamotrigine is effective and safe in preventing depressive relapses. Psychotherapy and psychoeducation represent effective adjunctive treatments.

Conclusion: In the treatment of BP depression there is not a specific effective treatment for all the patients. Interventions should therefore be personalised and the scientific evidence should be adapted to each patient's clinical features.

Keywords

antidepressantsbipolar disorderdepressiondopamine-agonistselectroconvulsive therapymood stabiliserspsychotherapy
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 23 , Issue 3 , June 2011 , pp. 94 - 105
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Goodwin, GM.Prophylaxis of bipolar disorder: how and who should we treat in the long term? Eur Neuropsychopharmacol 1999;9(Suppl. 4):S125–S129.CrossRefGoogle ScholarPubMed
2.Judd, LL, Akiskal, HS, Schettler, PJ et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002;59:530–537.CrossRefGoogle ScholarPubMed
3.Judd, LL, Akiskal, HS, Schettler, PJ et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003;60:261–269.CrossRefGoogle ScholarPubMed
4.Baldassano, CF, Ballas, CA, O'Reardon, JP.Rethinking the treatment paradigm for bipolar depression: the importance of long-term management. CNS Spectr 2004;9(Suppl. 9):11–18.CrossRefGoogle ScholarPubMed
5.Suppes, T, Dennehy, EB, Gibbons, EW.The longitudinal course of bipolar disorder. J Clin Psychiatry 2000;61(Suppl. 9):23–30.Google ScholarPubMed
6.Calabrese, JR, Hirschfeld, RM, Frye, MA, Reed, ML.Impact of depressive symptoms compared with manic symptoms in bipolar disorder: results of a U.S. community-based sample. J Clin Psychiatry 2004;65:1499–1504.CrossRefGoogle Scholar
7.Ghaemi, SN, Boiman, EE, Goodwin, FK.Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study. J Clin Psychiatry 2000;61:804–808.CrossRefGoogle ScholarPubMed
8.McIntyre, RS, Muzina, DJ, Kemp, DE et al. Bipolar disorder and suicide: research synthesis and clinical translation. Curr Psychiatry Rep 2008;10:66–72.CrossRefGoogle ScholarPubMed
9.Yatham, LN, Kennedy, SH, Schaffer, A et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disord 2009;11:225–255.CrossRefGoogle Scholar
10APA. Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2002. URL http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm (accessed on 2 February 2009).Google Scholar
11.Ghaemi, SN, Hsu, DJ, Soldani, F, Goodwin, FK.Antidepressants in bipolar disorder: the case for caution. Bipolar Disord 2003;5:421–433.CrossRefGoogle ScholarPubMed
12.Goodwin, FK, Jamison, KR.Manic depressive illness and recurrent depression, 2nd edn.New York: Oxford University Press, 2007: 754–756.Google Scholar
13.Grunze, H, Kasper, S, Goodwin, G et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of bipolar disorders. Part I: treatment of bipolar depression. World J Biol Psychiatry 2002;3:115–124.CrossRefGoogle ScholarPubMed
14.Möller, HJ, Grunze, H.Have some guidelines for the treatment of acute bipolar depression gone too far in the restriction of antidepressants?. Eur Arch Psychiatry Clin Neurosci 2000;250:57–68.Google ScholarPubMed
15.Möller, HJ, Grunze, H, Broich, K.Do recent efficacy data on the drug treatment of acute bipolar depression support the position that drugs other than antidepressants are the treatment of choice? A conceptual review. Eur Arch Psychiatry Clin Neurosci 2006;256:1–16.CrossRefGoogle Scholar
16.Gijsman, HJ, Geddes, JR, Rendell, JM, Nolen, WA, Goodwin, GM.Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Am J Psychiatry 2004;161:1537–1547.CrossRefGoogle ScholarPubMed
17.Mendlewicz, J, Youdim, MB.Antidepressant potentiation of 5-hydroxytryptophan by l-deprenil in affective illness. J Affect Disord 1980;2:137–146.CrossRefGoogle ScholarPubMed
18.Himmelhoch, JM, Fuchs, CZ, Symons, BJ.A double-blind study of tranylcypromine treatment of major anergic depression. J Nerv Ment Dis 1982;170:628–634.CrossRefGoogle ScholarPubMed
19.Cohn, JB, Collins, G, Ashbrook, E, Wernicke, JF.A comparison of fluoxetine imipramine and placebo in patients with bipolar depressive disorder. Int Clin Psychopharmacol 1989;4:313–322.CrossRefGoogle ScholarPubMed
20.Nemeroff, CB, Evans, DL, Gyulai, L et al. Double-blind, placebo-controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. Am J Psychiatry 2001;158:906–912.CrossRefGoogle ScholarPubMed
21.Tohen, M, Vieta, M, Calabrese, E, Ketter, J et al. Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatr 2003;60:1079–1088.CrossRefGoogle ScholarPubMed
22.Fabre, LF, Brodie, HK, Garver, D, Zung, WW.A multicenter evaluation of bupropion versus placebo in hospitalized depressed patients. J Clin Psychiatry 1983;44(5 Pt 2):88–94.Google ScholarPubMed
23.Merideth, CH, Feighner, JP.The use of bupropion in hospitalized depressed patients. J Clin Psychiatry 1983;44(5 Pt 2):85–87.Google ScholarPubMed
24.Himmelhoch, JM, Thase, ME, Mallinger, AG, Houck, P.Tranylcypromine versus imipramine in anergic bipolar depression. Am J Psychiatry 1991;148:910–916.Google ScholarPubMed
25.Thase, ME, Mallinger, AG, McKnight, D, Himmelhoch, JM.Treatment of imipramine-resistant recurrent depression, IV: a double-blind crossover study of tranylcypromine for anergic bipolar depression. Am J Psychiatry 1992;149:195–198.Google Scholar
26.Silverstone, T.Moclobemide vs. imipramine in bipolar depression: a multicentre double-blind clinical trial. Acta Psychiatr Scand 2001;104:104–109.CrossRefGoogle ScholarPubMed
27.Sachs, GS, Lafer, B, Stoll, AL et al. A double-blind trial of bupropion versus desipramine for bipolar depression. J Clin Psychiatry 1994;55:391–393.Google ScholarPubMed
28.Vieta, E, Martinez-Aran, A, Goikolea, JM et al. A randomized trial comparing paroxetine and venlafaxine in the treatment of bipolar depressed patients taking mood stabilizers. J Clin Psychiatry 2002;63:508–512.CrossRefGoogle ScholarPubMed
29.Post, RM, Altshuler, LL, Leverich, GS et al. Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. Br J Psychiatry 2006;189:124–131.CrossRefGoogle ScholarPubMed
30.Frazier, JA, Chiu, S, Breeze, JL et al. Structural brain magnetic resonance imaging of limbic and thalamic volumes in pediatric bipolar disorder. Am J Psychiatry 2005;162:1256–1265.CrossRefGoogle ScholarPubMed
31.Fisfalen, ME, Schulze, TG, DePaulo, JR Jr, DeGroot, LJ, Badner, JA, McMahon, FJ.Familial variation in episode frequency in bipolar affective disorder. Am J Psychiatry 2005;162:1266–1272.CrossRefGoogle ScholarPubMed
32.Ghaemi, SN, Rosenquist, KJ, Ko, JY, Baldassano, CF, Kontos, NJ, Baldessarini, RJ.Antidepressant treatment in bipolar versus unipolar depression. Am J Psychiatry 2004;161:163–165.CrossRefGoogle ScholarPubMed
33.Amsterdam, JD, Garcia-Espana, F.Venlafaxine monotherapy in women with bipolar II and unipolar major depression. J Affect Disord 2000;59:225–229.CrossRefGoogle ScholarPubMed
34.Amsterdam, J.Efficacy and safety of venlafaxine in the treatment of bipolar II major depressive episode. J Clin Psychopharmacol 1998;18:414–417.CrossRefGoogle ScholarPubMed
35.Moller, HJ, Bottlender, R, Grunze, H, Strauss, A, Wittmann, J.Are antidepressants less effective in the acute treatment of bipolar I compared to unipolar depression? J Affect Disord 2001;67:141–146.CrossRefGoogle ScholarPubMed
36.Bottlender, R, Rudolf, D, Jager, M, Strauss, A, Möller, HJ.Are bipolar I depressive patients less responsive to treatment with antidepressants than unipolar depressive patients? Results from a case control study. Eur Psychiatry 2002;17:200–205.CrossRefGoogle ScholarPubMed
37.Agosti, V, Stewart, JW.Efficacy and safety of antidepressant monotherapy in the treatment of bipolar-II depression. Int Clin Psychopharmacol 2007;22:309–311.CrossRefGoogle ScholarPubMed
38.Young, LT, Joffe, RT, Robb, JC, MacQueen, GM, Marriott, M, Patelis-Siotis, I.Double-blind comparison of addition of a second mood stabilizer versus an antidepressant to an initial mood stabilizer for treatment of patients with bipolar depression. Am J Psychiatry 2000;157:124–126.CrossRefGoogle Scholar
39.Sachs, GS, Nierenberg, AA, Calabrese, JR et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med 2007;356:1711–1722.CrossRefGoogle ScholarPubMed
40.Brown, EB, McElroy, SL, Keck, PE et al. A 7-week, randomized, double-blind trial of olanzapine/fluoxetine combination versus lamotrigine in the treatment of bipolar I depression. J Clin Psychiatry 2006;67:1025–1033.CrossRefGoogle ScholarPubMed
41.Goodwin, FK, Jamison, KR.Manic depressive illness and recurrent depression, 2nd edn.New York: Oxford University Press, 2007: 771–781.Google Scholar
42.Goldberg, JF, Truman, CJ.Antidepressant-induced mania: an overview of current controversies. Bipolar Disord 2003;5:407–420CrossRefGoogle ScholarPubMed
43.Carlson, GA, Finch, SJ, Fochtmann, LJ et al. Antidepressant-associated switches from depression to mania in severe bipolar disorder. Bipolar Disord 2007;9:851–859.CrossRefGoogle ScholarPubMed
44.Bauer, M, Rasgon, N, Grof, P et al. Mood changes related to antidepressants: a longitudinal study of patients with bipolar disorder in a naturalistic setting. Psychiatry Res 2005;133:73–80.CrossRefGoogle Scholar
45.Frankle, WG, Perlis, RH, Deckersbach, T et al. Bipolar depression: relationship between episode length and antidepressant treatment. Psychol Med 2002;32:1417–1423.CrossRefGoogle ScholarPubMed
46.Altshuler, L, Suppes, T, Black, D et al. Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up. Am J Psychiatry 2003;160:1252–1262.CrossRefGoogle ScholarPubMed
47.Angst, J.Switch from depression to mania – a record study over decades between 1920 and 1982. Psychopathology 1985;18:140–154.CrossRefGoogle Scholar
48.Bauer, M, Rasgon, N, Grof, P et al. Do antidepressants influence mood patterns? A naturalistic study in bipolar disorder. Eur Psychiatry 2006;21:262–269.CrossRefGoogle ScholarPubMed
49.Licht, RW, Gijsman, H, Nolen, WA, Angst, J.Are antidepressants safe in the treatment of bipolar depression? A critical evaluation of their potential risk to induce switch into mania or cycle acceleration. Acta Psychiatr Scand 2008;118:337–346.CrossRefGoogle ScholarPubMed
50.Wehr, TA, Goodwin, FK.Rapid cycling in manic-depressives induced by tricyclic antidepressants. Arch Gen Psychiatry 1979;36:555–559.CrossRefGoogle ScholarPubMed
51.Boerlin, HL, Gitlin, MJ, Zoellner, LA, Hammen, CL.Bipolar depression and antidepressant-induced mania: a naturalistic study. J Clin Psychiatry 1998;59:374–379.CrossRefGoogle Scholar
52.Peet, M.Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants. Br J Psychiatry 1994;164:549–550.CrossRefGoogle ScholarPubMed
53.Leverich, GS, Altshuler, LL, Frye, MA et al. Risk of switch in mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers. Am J Psychiatry 2006;163:232–239.CrossRefGoogle ScholarPubMed
54.Shopsin, B.Bupropion's prophylactic efficacy in bipolar affective illness. J Clin Psychiatry 1983;44(5 Pt 2):163–169.Google ScholarPubMed
55.Wright, G, Galloway, L, Kim, J, Dalton, M, Miller, L, Stern, W.Bupropion in the long-term treatment of cyclic mood disorders: mood stabilizing effects. J Clin Psychiatry 1985;46:22–25.Google ScholarPubMed
56.Haykal, RF, Akiskal, HS.Bupropion as a promising approach to rapid cycling bipolar II patients. J Clin Psychiatry 1990;51:450–455.Google ScholarPubMed
57.Henry, C, Sorbara, F, Lacoste, J, Gindre, C, Leboyer, M.Antidepressant-induced mania in bipolar patients: identification of risk factors. J Clin Psychiatry 2001;62:249–255.CrossRefGoogle ScholarPubMed
58.Bottlender, R, Rudolf, D, Strauss, A, Moller, HJ.Antidepressant-associated maniform states in acute treatment of patients with bipolar-I depression. Eur Arch Psychiatry Clin Neurosci 1998;248:296–300.CrossRefGoogle ScholarPubMed
59.Goldberg, JF, Whiteside, JE.The association between substance abuse and antidepressant-induced mania in bipolar disorder: a preliminary study. J Clin Psychiatry 2002;63:791–795.CrossRefGoogle ScholarPubMed
60.Stoll, AL, Mayer, PV, Kolbrener, M et al. Antidepressant-associated mania: a controlled comparison with spontaneous mania. Am J Psychiatry 1994;151:1642–1645.Google Scholar
61.Serretti, A, Artioli, P, Zanardi, R, Rossini, D.Clinical features of antidepressant associated manic and hypomanic switches in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2003;27:751–757.CrossRefGoogle ScholarPubMed
62.Manwani, SG, Pardo, TB, Albanese, MJ, Zablotsky, B, Goodwin, FK, Ghaemi, SN.Substance use disorder and other predictors of antidepressant-induced mania: a retrospective chart review. J Clin Psychiatry 2006;67:1341–1345.CrossRefGoogle ScholarPubMed
63.Mundo, E, Cattaneo, E, Russo, M, Altamura, AC.Clinical variables related to antidepressant-induced mania in bipolar disorder. J Affect Disord 2006;92:227–230.CrossRefGoogle ScholarPubMed
64.Frye, MA, Helleman, G, McElroy, SL et al. Correlates of treatment-emergent mania associated with antidepressant treatment in bipolar depression. Am J Psychiatry 2009;166:164–172.CrossRefGoogle ScholarPubMed
65.Bottlender, R, Sato, T, Kleindienst, N, Strauss, A, Moller, HJ.Mixed depressive features predict maniform switch during treatment of depression in bipolar I disorder. J Affect Disord 2004;78:149–152.CrossRefGoogle ScholarPubMed
66.Bond, DJ, Noronha, MM, Kauer-Sant'Anna, M, Lam, RW, Yatham, LN.Antidepressant-associated mood elevations in bipolar II disorder compared with bipolar I disorder and major depressive disorder: a systematic review and meta-analysis. J Clin Psychiatry 2008;69:1589–1601.CrossRefGoogle ScholarPubMed
67.Salvi, V, Fagiolini, A, Swartz, HA, Maina, G, Frank, E.The use of antidepressants in bipolar disorder. J Clin Psychiatry 2008;69:1307–1318.CrossRefGoogle ScholarPubMed
68MHRA. Safety of Selective Serotonin Reuptake Inhibitor Antidepressant, 2004. URL http://www.mhra.gov.uk/news/2004/SSRIs (accessed on 9 March 2009).Google Scholar
69.Fergusson, D, Doucette, S, Glass, KC et al. Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. BMJ 2005;330:396.CrossRefGoogle ScholarPubMed
70.Baldessarini, RJ, Pompili, M, Tondo, L.Suicidal risk in antidepressant drug trials. Arch Gen Psychiatry 2006;63:246–248.CrossRefGoogle ScholarPubMed
71.Gibbons, RD, Hur, K, Bhaumik, DK, Mann, JJ.The relationship between antidepressant medication use and rate of suicide. Arch Gen Psychiatry 2005;62:165–172.CrossRefGoogle Scholar
72.Gunnell, D, Saperia, J, Ashby, D.Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA's safety review. BMJ 2005;330:385.CrossRefGoogle Scholar
73.Yerevanian, BI, Koek, RJ, Mintz, J, Akiskal, HS.Bipolar pharmacotherapy and suicidal behavior. Part 2. The impact of antidepressants. J Affect Disord 2007;103:13–21.CrossRefGoogle ScholarPubMed
74.McElroy, SL, Kotwal, R, Kaneria, R, Keck, PE Jr.Antidepressants and suicidal behavior in bipolar disorder. Bipolar Disord 2006;8(5 Pt 2):596–617.CrossRefGoogle ScholarPubMed
75.Bauer, MS, Wisniewski, SR, Kogan, JN, Marangell, LB, Thase, ME, Sachs, G.Brief report: paroxetine in younger and adult individuals at high risk for suicide. Psychopharmacol Bull 2006;39:31–37.Google ScholarPubMed
76.Bauer, MS, Wisniewski, SR, Marangell, LB et al. Are antidepressants associated with new-onset suicidality in bipolar disorder? A prospective study of participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). J Clin Psychiatry 2006;67:48–55.CrossRefGoogle ScholarPubMed
77.Tondo, L, Lepri, B, Baldessarini, RJ.Suicidal status during antidepressant treatment in 789 Sardinian patients with major affective disorder. Acta Psychiatr Scand 2008;118:106–115.CrossRefGoogle ScholarPubMed
78.Ghaemi, SN, Wingo, AP, Filkowski, MA, Baldessarini, RJ.Long-term antidepressant treatment in bipolar disorder: meta-analyses of benefits and risks. Acta Psychiatr Scand 2008;118:347–356.CrossRefGoogle ScholarPubMed
79.Altshuler, L, Kiriakos, L, Calcagno, J et al. The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression: a retrospective chart review. J Clin Psychiatry 2001;62:612–616.CrossRefGoogle ScholarPubMed
80.Joffe, RT, MacQueen, GM, Marriott, M, Young, LT.One-year outcome with antidepressant – treatment of bipolar depression. Acta Psychiatr Scand 2005;112:105–109.CrossRefGoogle ScholarPubMed
81.Altshuler, LL, Post, RM, Hellemann, G et al. Impact of antidepressant continuation after acute positive or partial treatment response for bipolar depression: a blinded, randomized study. J Clin Psychiatry 2009;70:450–457.CrossRefGoogle ScholarPubMed
82.Grunze, HC.Switching, induction of rapid cycling, and increased suicidality with antidepressants in bipolar patients: fact or overinterpretation? CNS Spectr 2008;13:790–795.CrossRefGoogle ScholarPubMed
83.Ghaemi, SN.Treatment of rapid-cycling bipolar disorder: are antidepressants mood destabilizers? Am J Psychiatry 2008;165:300–302.CrossRefGoogle ScholarPubMed
84.Quitkin, FM, Kane, J, Rifkin, A, Ramos-Lorenzi, JR, Nayak, DV.Prophylactic lithium carbonate with and without imipramine for bipolar 1 patients: a double-blind study. Arch Gen Psychiatry 1981;38:902–907.CrossRefGoogle ScholarPubMed
85.Wehr, TA, Sack, DA, Rosenthal, NE, Cowdry, RW.Rapid cycling affective disorder: contributing factors and treatment responses in 51 patients. Am J Psychiatry 1988;145:179–184.Google ScholarPubMed
86.Kupka, RW, Luckenbaugh, DA, Post, RM et al. Comparison of rapid-cycling and non-rapid-cycling bipolar disorder based on prospective mood ratings in 539 outpatients. Am J Psychiatry 2005;162:1273–1280.CrossRefGoogle ScholarPubMed
87.Altshuler, LL, Post, RM, Leverich, GS, Mika-lauskas, K, Rosoff, A, Ackerman, L.Antidepressant-induced mania and cycle acceleration: a controversy revisited. Am J Psychiatry 1995;152:1130–1138.Google ScholarPubMed
88.Kupfer, DJ, Carpenter, LL, Frank, E.Possible role of antidepressants in precipitating mania and hypomania in recurrent depression. Am J Psychiatry 1988;145:804–808.Google ScholarPubMed
89.Tondo, L, Laddomada, P, Serra, G, Minnai, G, Kukopulos, A.Rapid cyclers and antidepressants. Int Pharmacopsychiatry 1981;16:119–123.CrossRefGoogle ScholarPubMed
90.Kukopulos, A, Caliari, B, Tundo, A et al. Rapid cyclers, temperament, and antidepressants. Compr Psychiatry 1983; 24:249–258.CrossRefGoogle ScholarPubMed
91.Hurowitz, GI, Liebowitz, MR.Antidepressant-induced rapid cycling: six case reports. J Clin Psychopharmacol 1993;13:52–56.CrossRefGoogle ScholarPubMed
92.Coryell, W, Solomon, D, Turvey, C et al. The long-term course of rapid-cycling bipolar disorder. Arch Gen Psychiatry 2003;60:914–920.CrossRefGoogle ScholarPubMed
93.Mattes, JA.Antidepressant-induced rapid cycling: another perspective. Ann Clin Psychiatry 2006;18:195–199.CrossRefGoogle ScholarPubMed
94.Mendels, J, Frazer, A.Intracellular lithium concentration and clinical response: towards a membrane theory of depression. J Psychiatr Res 1973;10:9–18.CrossRefGoogle ScholarPubMed
95.Goodwin, FK, Murphy, DL, Dunner, DL, Bunney, WE Jr.Lithium response in unipolar versus bipolar depression. Am J Psychiatry 1972;129:44–47.CrossRefGoogle ScholarPubMed
96.Baron, M, Gershon, ES, Rudy, V, Jonas, WZ, Buchsbaum, M.Lithium carbonate response in depression: prediction by unipolar/bipolar illness, average-evoked response, catechol-O-methyl transferase, and family history. Arch Gen Psychiatry 1975;32:1107–1111.CrossRefGoogle ScholarPubMed
97.Noyes, R Jr, Dempsey, GM.Lithium treatment of depression. Dis Nerv Syst 1974;35:573–576.Google ScholarPubMed
98.Mendels, J.Lithium in the treatment of depression. Am J Psychiatry 1976;133:373–378.Google ScholarPubMed
99.Donnelly, EF, Goodwin, FK, Waldman, IN, Murphy, DL.Prediction of antidepressant responses to lithium. Am J Psychiatry 1978;135:552–556.Google ScholarPubMed
100.Tondo, L, Baldessarini, RJ.Reduced suicide risk during lithium maintenance treatment. J Clin Psychiatry 2000;61(Suppl. 9):97–104.Google ScholarPubMed
101.Lauterbach, E, Felber, W, Muller-Oerlinghausen, B et al. Adjunctive lithium treatment in the prevention of suicidal behaviour in depressive disorders: a randomised, placebo-controlled, 1-year trial. Acta Psychiatr Scand 2008;118:469–479.CrossRefGoogle ScholarPubMed
102.Carney, SM, Goodwin, GM.Lithium – a continuing story in the treatment of bipolar disorder. Acta Psychiatr Scand Suppl 2005;426:7–12.CrossRefGoogle Scholar
103.Geddes, JR, Burgess, S, Hawton, K, Jamison, K, Goodwin, GM.Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry 2004;161:217–222.CrossRefGoogle ScholarPubMed
104.Smith, LA, Cornelius, V, Warnock, A, Bell, A, Young, AH.Effectiveness of mood stabilizers and antipsychotics in the maintenance phase of bipolar disorder: a systematic review of randomized controlled trials. Bipolar Disord 2007;9:394–412.CrossRefGoogle ScholarPubMed
105.Geddes, JR, Calabrese, JR, Goodwin, GM.Lamotrigine for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials. Br J Psychiatry 2009;194:4–9.CrossRefGoogle ScholarPubMed
106.Suppes, T, Marangell, LB, Bernstein, IH et al. A single blind comparison of lithium and lamotrigine for the treatment of bipolar II depression. J Affect Disord 2008;111:334–343.CrossRefGoogle ScholarPubMed
107.van der Loos, ML, Mulder, PG, Hartong, EG et al. Efficacy and safety of lamotrigine as add-on treatment to lithium in bipolar depression: a multicenter, double-blind, placebo-controlled trial. J Clin Psychiatry 2009;70:223–231.CrossRefGoogle ScholarPubMed
108.van der Loos, ML, Kolling, P, Knoppert-van der Klein, EA, Nolen, WA.[Lamotrigine in the treatment of bipolar disorder, a review]. Tijdschr Psychiatr 2007;49:95–103.Google ScholarPubMed
109.Calabrese, JR, Huffman, RF, White, RL et al. Lamotrigine in the acute treatment of bipolar depression: results of five double-blind, placebo-controlled clinical trials. Bipolar Disord 2008;10:323–333.CrossRefGoogle ScholarPubMed
110.Davis, LL, Bartolucci, A, Petty, F.Divalproex in the treatment of bipolar depression: a placebo-controlled study. J Affect Disord 2005;85:259–266.CrossRefGoogle ScholarPubMed
111.Ghaemi, SN, Gilmer, WS, Goldberg, JF et al. Divalproex in the treatment of acute bipolar depression: a preliminary double-blind, randomized, placebo-controlled pilot study. J Clin Psychiatry 2007;68:1840–1844.CrossRefGoogle ScholarPubMed
112.Gyulai, L, Bowden, CL, McElroy, SL et al. Maintenance efficacy of divalproex in the prevention of bipolar depression. Neuropsychopharmacology 2003;28:1374–1382.CrossRefGoogle ScholarPubMed
113.Kemp, DE, Keming, G, Calabrese, JR. Antiepilectic drugs in the treatment of rapid-cycling bipolar disorder and bipolar depression. In: McElroy, S, Keck, PE, Post, RM, eds. Antiepilectic drugs to treat psychiatric disorders. London: Informa Healthcare, 2008: 155–176.Google Scholar
114.Wang, PW, Santosa, C, Schumacher, M, Winsberg, ME, Strong, C, Ketter, TA.Gabapentin augmentation therapy in bipolar depression. Bipolar Disord 2002;4:296–301.CrossRefGoogle ScholarPubMed
115.Pande, AC, Crockatt, JG, Janney, CA, Werth, JL, Tsaroucha, G.Gabapentin in bipolar disorder: a placebo-controlled trial of adjunctive therapy, Gabapentin Bipolar Disorder Study Group Bipolar Disord 2000;2(3 Pt 2):249–255.CrossRefGoogle ScholarPubMed
116.Vieta, E, Torrent, C, Garcia-Ribas, G et al. Use of topiramate in treatment-resistant bipolar spectrum disorders. J Clin Psychopharmacol 2002;22:431–435.CrossRefGoogle ScholarPubMed
117.McElroy, SL, Suppes, T, Keck, PE et al. Open-label adjunctive topiramate in the treatment of bipolar disorders. Biol Psychiatry 2000;47:1025–1033.CrossRefGoogle ScholarPubMed
118.Zarate, CA Jr, Payne, JL, Singh, J et al. Pramipexole for bipolar II depression: a placebo-controlled proof of concept study. Biol Psychiatry 2004;56:54–60.CrossRefGoogle ScholarPubMed
119.Lattanzi, L, Dell'Osso, L, Cassano, P et al. Pramipexole in treatment-resistant depression: a 16-week naturalistic study. Bipolar Disord 2002;4:307–314.CrossRefGoogle ScholarPubMed
120.Goldberg, JF, Burdick, KE, Endick, CJ.Preliminary randomized, double-blind, placebo-controlled trial of pramipexole added to mood stabilizers for treatment-resistant bipolar depression. Am J Psychiatry 2004;161:564–566.CrossRefGoogle ScholarPubMed
121.Aiken, CB.Pramipexole in psychiatry: a systematic review of the literature. J Clin Psychiatry 2007;68:1230–1236.CrossRefGoogle ScholarPubMed
122.Frye, MA, Grunze, H, Suppes, T et al. A placebo-controlled evaluation of adjunctive modafinil in the treatment of bipolar depression. Am J Psychiatry 2007;164:1242–1249.CrossRefGoogle ScholarPubMed
123.Nierenberg, AA.Combined olanzapine plus fluoxetine modestly improves symptoms of acute bipolar I depression compared to lamotrigine. Evid Based Ment Health 2007;10:12.CrossRefGoogle ScholarPubMed
124.Brown, E, Dunner, DL, McElroy, SL et al. Olanzapine/fluoxetine combination vs. lamotrigine in the 6-month treatment of bipolar I depression. Int J Neuropsychopharmacol 2009;12:773–782.CrossRefGoogle ScholarPubMed
125.Calabrese, JR, Keck, PE Jr, Macfadden, W et al. A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. Am J Psychiatry 2005;162:1351–1360.CrossRefGoogle ScholarPubMed
126.Thase, ME, Macfadden, W, Weisler, RH et al. Efficacy of quetiapine monotherapy in bipolar I and II depression: a double-blind, placebo-controlled study (the BOLDER II study). J Clin Psychopharmacol 2006;26:600–609.CrossRefGoogle Scholar
127.Weisler, RH, Calabrese, JR, Thase, ME et al. Efficacy of quetiapine monotherapy for the treatment of depressive episodes in bipolar I disorder: a post hoc analysis of combined results from 2 double-blind, randomized, placebo-controlled studies. J Clin Psychiatry 2008;69:769–782.CrossRefGoogle ScholarPubMed
128.Cookson, J, Keck, PE Jr, Ketter, TA, Macfadden, W.Number needed to treat and time to response/remission for quetiapine monotherapy efficacy in acute bipolar depression: evidence from a large, randomized, placebo-controlled study. Int Clin Psychopharmacol 2007;22:93–100.CrossRefGoogle ScholarPubMed
129.Endicott, J, Rajagopalan, K, Minkwitz, M, Macfadden, W.A randomized, double-blind, placebo-controlled study of quetiapine in the treatment of bipolar I and II depression: improvements in quality of life. Int Clin Psychopharmacol 2007;22:29–37.Google ScholarPubMed
130.Endicott, J, Paulsson, B, Gustafsson, U, Schioler, H, Hassan, M.Quetiapine monotherapy in the treatment of depressive episodes of bipolar I and II disorder: Improvements in quality of life and quality of sleep. J Affect Disord 2008;111:306–319.CrossRefGoogle ScholarPubMed
131.Shelton, RC, Stahl, SM.Risperidone and paroxetine given singly and in combination for bipolar depression. J Clin Psychiatry 2004;65:1715–1719.CrossRefGoogle ScholarPubMed
132.Vieta, E, Goikolea, JM, Corbella, B et al. Risperidone safety and efficacy in the treatment of bipolar and schizoaffective disorders: results from a 6-month, multicenter, open study. J Clin Psychiatry 2001;62:818–825.CrossRefGoogle ScholarPubMed
133.McIntyre, RS, Mancini, DA, Srinivasan, J, McCann, S, Konarski, JZ, Kennedy, SH.The antidepressant effects of risperidone and olanzapine in bipolar disorder. Can J Clin Pharmacol 2004;11:e218–e226.Google ScholarPubMed
134.Thase, ME, Jonas, A, Khan, A et al. Aripiprazole monotherapy in nonpsychotic bipolar I depression: results of 2 randomized, placebo-controlled studies. J Clin Psychopharmacol 2008;28:13–20.CrossRefGoogle ScholarPubMed
135.Kemp, DE, Dago, PL, Straus, JL, Fleck, J, Karaffa, M, Gilmer, WS.Aripiprazole augmentation for treatment-resistant bipolar depression: sustained remission after 36 months. J Clin Psychopharmacol 2007;27:304–305.CrossRefGoogle Scholar
136.Kemp, DE, Gilmer, WS, Fleck, J, Straus, JL, Dago, PL, Karaffa, M.Aripiprazole augmentation in treatment-resistant bipolar depression: early response and development of akathisia. Prog Neuropsychopharmacol Biol Psychiatry 2007;31:574–577.CrossRefGoogle ScholarPubMed
137.Black, DW, Winokur, G, Nasrallah, A.The treatment of depression: electroconvulsive therapy v antidepressants: a naturalistic evaluation of 1,495 patients. Compr Psychiatry 1987;28:169–182.CrossRefGoogle Scholar
138.Zorumski, CF, Rutherford, JL, Burke, WJ, Reich, T.ECT in primary and secondary depression. J Clin Psychiatry 1986;47:298–300.Google ScholarPubMed
139.Russell, JC, Rasmussen, KG, O'Connor, MK, Copeman, CA, Ryan, DA, Rummans, TA.Long-term maintenance ECT: a retrospective review of efficacy and cognitive outcome. J ECT 2003;19:4–9.CrossRefGoogle ScholarPubMed
140.Prudic, J, Olfson, M, Marcus, SC, Fuller, RB, Sackeim, HA.Effectiveness of electroconvulsive therapy in community settings. Biol Psychiatry 2004;55:301–312.CrossRefGoogle ScholarPubMed
141UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003;361:799–808.CrossRefGoogle Scholar
142.Maletzky, BM.The first-line use of electroconvulsive therapy in major affective disorders. J ECT 2004;20:112–117.CrossRefGoogle ScholarPubMed
143.Dolberg, OT, Dannon, PN, Schreiber, S, Grunhaus, L.Transcranial magnetic stimulation in patients with bipolar depression: a double blind, controlled study. Bipolar Disord 2002;4(Suppl. 1):94–95.CrossRefGoogle ScholarPubMed
144.Nahas, Z, Kozel, FA, Li, X, Anderson, B, George, MS.Left prefrontal transcranial magnetic stimulation (TMS) treatment of depression in bipolar affective disorder: a pilot study of acute safety and efficacy. Bipolar Disord 2003;5:40–47.CrossRefGoogle ScholarPubMed
145.Tamas, RL, Menkes, D, El-Mallakh, RS.Stimulating research: a prospective, randomized, double-blind, sham-controlled study of slow transcranial magnetic stimulation in depressed bipolar patients. J Neuropsychiatry Clin Neurosci 2007;19:198–199.CrossRefGoogle ScholarPubMed
146.Dell'Osso, B, Mundo, E, D'Urso, N et al. Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug-resistant bipolar depression. Bipolar Disord 2009;11:76–81.CrossRefGoogle ScholarPubMed
147.Swartz, HA, Frank, E, Frankel, DR, Novick, D, Houck, P.Psychotherapy as monotherapy for the treatment of bipolar II depression: a proof of concept study. Bipolar Disord 2009;11:89–94.CrossRefGoogle ScholarPubMed
148.Miklowitz, DJ.Adjunctive psychotherapy for bipolar disorder: state of the evidence. Am J Psychiatry 2008;165:1408–1419.CrossRefGoogle ScholarPubMed