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Treatment of bipolar depression

Published online by Cambridge University Press:  08 February 2013

Laura Musetti ,
Claudia Del Grande ,
Donatella Marazziti  and
Liliana Dell'Osso
Laura Musetti*
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Claudia Del Grande
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Donatella Marazziti
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Liliana Dell'Osso
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
*
*Address for correspondence: Laura Musetti, MD, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy. (Email [email protected])
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Abstract

Depressive symptoms and episodes dominate the long-term course of bipolar disorder and are associated with high levels of disability and an increased risk of suicide. However, the treatment of bipolar depression has been poorly investigated in comparison with that of manic episodes and unipolar major depressive disorder. The goal of treatment in bipolar depression is not only to achieve full remission of acute symptoms, but also to avoid long-term mood destabilization and to prevent relapses. A depressive presentation of bipolar disorder may often delay the appropriate management and, thus, worsen the long-term outcome. In these cases, an accurate screening for diagnostic indicators of a possible bipolar course of the illness should guide the therapeutic choices, and lead to prognostic improvement. Antidepressant use is still the most controversial issue in the treatment of bipolar depression. Despite inconclusive evidence of efficacy and tolerability, this class of agents is commonly prescribed in acute and long-term treatment, often in combination with mood stabilizers. In this article, we review available treatment options for bipolar depression, and we shall provide some suggestions for the management of the different presentations of depression in the course of bipolar disorder.

Keywords

Antidepressantsatypical antipsychoticsbipolar depressionbipolar spectrumdepressive mixed statemood stabilizersnonpharmacological treatmentpharmacological treatment
Type
Review Articles
Information
CNS Spectrums , Volume 18 , Issue 4 , August 2013 , pp. 177 - 187
Copyright
Copyright © Cambridge University Press 2013 

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