Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-16T15:32:50.320Z Has data issue: false hasContentIssue false
  • English
  • Français

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])
Get access Rights & Permissions [Opens in a new window]

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 

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.Judd, LL, Akiskal, HS, Schettler, PJ, etal. Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study. Arch Gen Psychiatry. 2005; 62(12): 1322–1330.CrossRefGoogle ScholarPubMed
2.Bauer, M, Ritter, P, Grunze, H, Pfenning, A. Treatment options for acute depression in bipolar disorder. Bipolar Disord. 2012; 14(suppl 2): 37–50.CrossRefGoogle ScholarPubMed
3.Amit, BH, Weizman, A. Antidepressant treatment for acute bipolar depression: an update. Depress Res Treat. 2012; 2012: 684725.Google ScholarPubMed
4.Post, RM, Denicoff, KD, Leverich, GS, etal. Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. J Clin Psychiatry. 2003; 64(6): 680–690.CrossRefGoogle ScholarPubMed
5.Judd, LL, Schettler, PJ, Akiskal, HS, etal. Residual symptom recovery from major affective episodes in bipolar disorders and rapid episode relapse/recurrence. Arch Gen Psychiatry. 2008; 65(4): 386–394.CrossRefGoogle ScholarPubMed
6.Angst, J, Angst, F, Gerber-Werder, R, Gamma, A. Suicide in 406 mod-disorder patients with and without long-term medication: a 40 to 44 years’ follow-up. Arch Suicide Res. 2005; 9(3): 279–300.CrossRefGoogle ScholarPubMed
7.Young, AH, Nemeroff, CB. Pharmacological treatment of bipolar depression. In: Yatham LN, Maj M, eds. Bipolar Disorder: Clinical and Neurobiological Foundations. Chichester, UK: John Wiley & Sons, Ltd; 2010: 294–303.CrossRefGoogle Scholar
8.Vieta, E, Colom, F, Corbella, B, etal. Clinical correlates of psychiatric comorbidity in bipolar I patients. Bipolar Disord. 2001; 3(5): 253–258.CrossRefGoogle ScholarPubMed
9.Hirschfeld, RMA, Lewis, L, Vornik, LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003; 64(2): 161–174.Google ScholarPubMed
10.Goodwin, FK, Jamison, KR. Manic-Depressive Illness, 2nd ed.New York: Oxford University Press; 2007.Google Scholar
11.Baldessarini, RJ, Vieta, E, Calabrese, JR, etal. Bipolar depression: overview and commentary. Harv Rev Psychiatry. 2010; 18(3): 143–157.CrossRefGoogle ScholarPubMed
12.Cassano, GB, Akiskal, HS, Savino, M, etal. Proposed subtypes of bipolar II disorder: with hypomanic episodes and/or with hyperthymic temperament. J Affect Disord. 1992; 26(2): 127–140.CrossRefGoogle ScholarPubMed
13.Akiskal, HS, Maser, JD, Zeller, PJ, etal. Switching from “unipolar” to bipolar II: an 11-year prospective study of clinical and temperamental predictors in 559 patients. Arch Gen Psychiatry. 1995; 52(2): 114–123.CrossRefGoogle Scholar
14.Perlis, RH, Brown, E, Baker, RW, Nirenberg, AA. Clinical features of bipolar depression vs. major depressive disorder in large multicenter trials. Am J Psychiatry. 2006; 163(2): 225–231.CrossRefGoogle Scholar
15.Thase, ME. Recognition and diagnosis of atypical depression. J Clin Psychiatry. 2007; 68(suppl 8): 11–16.Google ScholarPubMed
16.Merikangas, KR, Herrell, R, Swendsen, J, etal. Specificity of bipolar spectrum conditions in the comorbidity of mood and substance use disorders: results from the Zurich cohort study. Arch Gen Psychiatry. 2008; 65(1): 47–52.CrossRefGoogle ScholarPubMed
17.El-Mallakh, RS, Ghaemi, SN, Sagduyu, K, etal. STEP-BD Investigators. Antidepressant-associated chronic irritable dysphoria (ACID) in STEP-BD patients. J Affect Disord. 2008; 111(2–3): 372–377.CrossRefGoogle ScholarPubMed
18.Frye, MA, Helleman, G, McElroy, SL, etal. Correlates of treatment-emergent mania associated with antidepressant treatment in bipolar depression. Am J Psychiatry. 2009; 166(2): 164–172.CrossRefGoogle ScholarPubMed
19.Rybakowski, JK. Bipolarity and inadequate response to antidepressant drugs: clinical and psychopharmacological perspective. J Affect Disord. 2012; 136(1–2): e13–19.CrossRefGoogle ScholarPubMed
20.Constant, A, Castera, L, Dantzer, R, etal. Mood alterations during interferon-alfa therapy in patients with chronic hepatitis C: evidence for an overlap between manic/hypomanic and depressive symptoms. J Clin Psychiatry. 2005; 66(8): 1050–1057.CrossRefGoogle ScholarPubMed
21.Hardoy, MC, Cadeddu, M, Serra, A, etal. A pattern of cerebral perfusion anomalies between major depressive disorder and Hashimoto thyroiditis. BMC Psychiatry. 2011; 11: 148–154.CrossRefGoogle ScholarPubMed
22.Cassano, GB, Dell'Osso, L, Frank, E, etal. The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology. J Affect Disord. 1999; 54(3): 319–328.CrossRefGoogle Scholar
23.Akiskal, HS, Pinto, O. The soft bipolar spectrum: footnotes to Kraepelin on the interface of hypomania, temperament and depression. In: Marneros A, Angst J, eds. Bipolar Disorders: 100 Years After Manic-Depressive Insanity. Dordrecht, Netherlands: Kluwer Academic Publishers; 2000: 37–62.CrossRefGoogle Scholar
24.Dell'Osso, L, Armani, A, Rucci, P, etal. Measuring mood spectrum: comparison of interview (SCI-MOODS) and self-report (MOODS-SR) instruments. Compr Psychiatry. 2002; 43(1): 69–73.CrossRefGoogle ScholarPubMed
25.Goldberg, JF, Perlis, RH, Bowden, CL, etal. Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD. Am J Psychiatry. 2009; 166(2): 173–181.CrossRefGoogle Scholar
26.Goldberg, JF, Perlis, RH, Ghaemi, SN, etal. Adjunctive antidepressant use and symptomatic recovery among bipolar depressed patients with concomitant manic symptoms: findings from the STEP-BD. Am J Psychiatry. 2007; 164(9): 1348–1355.CrossRefGoogle ScholarPubMed
27.Kasper, S, Calabrese, JR, Johnson, G, etal. International Consensus Group on the evidence-based pharmacological treatment of bipolar I and II depression. J Clin Psychiatry. 2008; 69(10): 1632–1646.Google Scholar
28.Goodwin, GM. Consensus Group of the British Association for Psychopharmacology. Evidence-based guidelines for treating bipolar disorder: revised second edition—recommendations from the British Association for Psychopharmacology Journal of Psychopharmacology. J Psychopharmacol. 2009; 23(4): 346–388.CrossRefGoogle Scholar
29. National Institute for Health and Clinical Excellence. Bipolar disorder. The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. NICE Clinical Guideline 38, update 2009. http://guidance.nice.org.uk/CG38Google Scholar
30.Yatham, LN, Kennedy, SH, Schaffer, A, etal. 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(3): 225–255.CrossRefGoogle Scholar
31.Grunze, H, Vieta, E, Goodwin, GM, etal. WFSBP task Force on treatment guidelines for bipolar disorders. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2010 on the treatment of acute bipolar depression. World J Biol Psychiatry. 2010; 11(2): 81–109.CrossRefGoogle ScholarPubMed
32.Nivoli, AM, Colom, F, Murru, A, etal. New treatment guidelines for acute bipolar depression: a systematic review. J Affect Disord. 2011; 129(1–3): 14–26.CrossRefGoogle ScholarPubMed
33.Geddes, JR, Burgess, S, Hawton, K, etal. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry. 2004; 161(2): 217–222.CrossRefGoogle ScholarPubMed
34.Young, AH, McElroy, SL, Bauer, M, etal. EMBOLDEN I (Trial 001) Investigators. A double-blind, placebo-controlled study of quetiapine and lithium monotherapy in adults in the acute phase of bipolar depression (EMBOLDEN I). J Clin Psychiatry. 2010; 71(2): 150–162.CrossRefGoogle Scholar
35.Cipriani, A, Pretty, H, Hawton, K, Geddes, JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry. 2005; 162(10): 1805–1819.CrossRefGoogle ScholarPubMed
36.Baldessarini, RJ, Tondo, L, Davis, P, etal. Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review. Bipolar Disord. 2006; 8(5 pt 2): 625–639.CrossRefGoogle ScholarPubMed
37.Swartz, HA, Thase, ME. Pharmacotherapy for the treatment of acute bipolar II depression: current evidence. J Clin Psychiatry. 2011; 72(3): 356–366.CrossRefGoogle ScholarPubMed
38.Bowden, CL, Singh, V. Lamotrigine (Lamictal IR) for the treatment of bipolar disorder. Expert Opin Pharmacother. 2012; 13(17): 2565–2571.CrossRefGoogle ScholarPubMed
39.Calabrese, JR, Huffman, RF, White, RL, etal. Lamotrigine in the acute treatment of bipolar depression: results of five double-blind, placebo-controlled clinical trials. Bipolar Disord. 2008; 10(2): 323–333.CrossRefGoogle ScholarPubMed
40.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(1): 4–9.CrossRefGoogle ScholarPubMed
41.Calabrese, JR, Bowden, CL, Sachs, GS, etal. Double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. J Clin Psychiatry. 1999; 60(2): 79–88.CrossRefGoogle ScholarPubMed
42.van der Loos, ML, Mulder, PG, Hartong, EG, etal. 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(2): 223–231.CrossRefGoogle ScholarPubMed
43.Nierenberg, AA, Ostacher, MJ, Calabrese, JR, etal. Treatment-resistant bipolar depression: a STEP-BD equipoise randomized effectiveness trial of antidepressant augmentation with lamotrigine, inositol, or risperidone. Am J Psychiatry. 2006; 163(2): 210–216.CrossRefGoogle ScholarPubMed
44.Calabrese, JR, Suppes, T, Bowden, CL, etal. A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapid-cycling bipolar disorder: Lamictal 614 Study Group. J Clin Psychiatry. 2000; 61(11): 841–850.CrossRefGoogle ScholarPubMed
45.Goodwin, GM, Bowden, CL, Calabrese, JR, etal. A pooled analysis of 2 placebo-controlled 18-month trials of lamotrigine and lithium maintenance in bipolar I disorder. J Clin Psychiatry. 2004; 65(3): 432–441.CrossRefGoogle ScholarPubMed
46.Saunders, KEA, Goodwin, GM. New approaches in the treatment of bipolar depression. Curr Top Behav Neurosci. In press. DOI: 10.1007/7854_2012_209.Google Scholar
47.Smith, LA, Cornelius, VR, Azorin, JM, etal. Valproate for the treatment of acute bipolar depression: systematic review and meta-analysis. J Affect Disord. 2010; 122(1–2): 1–9.CrossRefGoogle ScholarPubMed
48.Bowden, CL, Calabrese, JR, McElroy, SL, etal. A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Arch Gen Psychiatry. 2000; 57(5): 481–489.CrossRefGoogle ScholarPubMed
49.Geddes, JR, Goodwin, GM, Rendell, J, etal. E. Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial. Lancet. 2010; 375(9712): 385–395.Google Scholar
50.Greil, W, Kleindienst, N, Erazo, N, Müller-Oerlinghausen, B. Differential response to lithium and carbamazepine in the prophylaxis of bipolar disorder. J Clin Psychopharmacol. 1998; 18(6): 455–460.CrossRefGoogle ScholarPubMed
51.Thase, ME, Macfadden, W, Weisler, RH, etal. 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(6): 600–609.CrossRefGoogle Scholar
52.Weisler, RH, Calabrese, JR, Thase, ME, etal. Efficacy of quetiapine monotherapy for the treatment of depressive episodes in bipolar I disorder: a post-hoc analysis of combined results from two double-blind, randomized, placebo-controlled studies. J Clin Psychiatry. 2008; 69(5): 769–782.CrossRefGoogle Scholar
53.Suppes, T, Vieta, E, Liu, S, Brecher, M, Paulsson, B. Trial 127 Investigators. Maintenance treatment for patients with bipolar I disorder: results from a North American study of quetiapine in combination with lithium or divalproex (Trial 127). Am J Psychiatry. 2009; 166(4): 476–488.CrossRefGoogle ScholarPubMed
54.McElroy, SL, Weisler, RH, Chang, W, etal. EMBOLDEN II (Trial D1447C00134) Investigators. A double-blind, placebo-controlled study of quetiapine and paroxetine as monotherapy in adults with bipolar depression (EMBOLDEN II). J Clin Psychiatry. 2010; 71(2): 163–174.CrossRefGoogle Scholar
55.Vieta, E, Suppes, T, Eggens, I, etal. Efficacy and safety of quetiapine in combination with lithium or divalproex for maintenance of patients with bipolar I disorder (international trial 126). J Affect Disord. 2008; 109(3): 251–263.CrossRefGoogle ScholarPubMed
56.Hardoy, MC, Garofalo, A, Carpiniello, B, etal. Combination quetiapine therapy in the long-term treatment of patients with bipolar I disorder. Clin Pract Epidemiol Ment Health. 2005; 18: 1–7.Google Scholar
57.Tohen, M, Vieta, E, Calabrese, J, etal. Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry. 2003; 60(11): 1079–1088.CrossRefGoogle ScholarPubMed
58.Brown, EB, Mcelroy, SL, Keck, PE Jr, etal. 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(7): 1025–1033.CrossRefGoogle ScholarPubMed
59.Tohen, M, Calabrese, JR, Sachs, GS, etal. Randomized, placebo-controlled trial of olanzapine as maintenance therapy in patients with bipolar I disorder responding to acute treatment with olanzapine. Am J Psychiatry. 2006; 163(2): 247–256.CrossRefGoogle ScholarPubMed
60.Tohen, M, Ketter, TA, Zarate, CA, etal. Olanzapine versus divalproex sodium for the treatment of acute mania and maintenance of remission: a 47-week study. Am J Psychiatry. 2003; 160(7): 1263–1271.CrossRefGoogle ScholarPubMed
61.Tohen, M, Greil, W, Calabrese, JR, etal. Olanzapine versus lithium in the maintenance treatment of bipolar disorder: 12-month, randomized, double-blind, controlled clinical trial. Am J Psychiatry. 2005; 162(7): 1281–1290.CrossRefGoogle ScholarPubMed
62.Thase, ME, Jonas, A, Khan, A, etal. Aripiprazole monotherapy in nonpsychotic bipolar I depression: results of 2 randomized, placebo-controlled studies. J Clin Psychopharmacol. 2008; 28(1): 13–20.CrossRefGoogle ScholarPubMed
63.Marcus, RN, McQuade, RD, Carson, WH, etal. The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a second multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychopharmacol. 2008; 28(2): 156–165.CrossRefGoogle ScholarPubMed
64.Keck, PE Jr, Calabrese, JR, McIntyre, RS, etal. Aripiprazole monotherapy for maintenance therapy in bipolar I disorder: a 100-week, double-blind study versus placebo. J Clin Psychiatry. 2007; 68(10): 1480–1491.CrossRefGoogle ScholarPubMed
65.Yerevanian, BI. The role of antidepressants in bipolar disorder. In: Akiskal HS, Tohen M, eds. Bipolar Psychopharmacotherapy: Caring for the Patient, 2nd ed.New York: John Wiley & Sons, Ltd.; 2011: 299–316.CrossRefGoogle Scholar
66.Baldessarini, RJ, Leahy, L, Arcona, S, etal. Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders. Psychiatr Serv. 2007; 58(1): 85–91.CrossRefGoogle ScholarPubMed
67.Carta, MG, Aguglia, E, Balestrieri, M, etal. The lifetime prevalence of bipolar disorders and the use of antidepressant drugs in bipolar depression in Italy. J Affect Disord. 2012; 136(3): 775–780.CrossRefGoogle ScholarPubMed
68.Sachs, GS, Nierenberg, AA, Calabrese, JR, etal. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007; 356(17): 1711–1722.CrossRefGoogle ScholarPubMed
69.Ghaemi, SN, Wingo, AP, Filkowski, MA, etal. Effectiveness of long-term antidepressant treatment in bipolar disorder: meta-analysis of benefits and risks. Acta Psychiatr Scand. 2008; 118(5): 347–356.CrossRefGoogle ScholarPubMed
70.Grunze, HC. Switching, induction of rapid cycling, and increased suicidality with antidepressants in bipolar patients: fact or overinterpretation? CNS Spectr. 2008; 13(9): 790–795.CrossRefGoogle ScholarPubMed
71.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(5): 337–346.CrossRefGoogle ScholarPubMed
72.Amsterdam, JD, Shults, J. Comparison of fluoxetine, olanzapine, and combined fluoxetine plus olanzapine initial therapy of bipolar type I and type II major depression—lack of manic induction. J Affect Disord. 2005; 87(1): 121–130.CrossRefGoogle ScholarPubMed
73.Altshuler, LL, Suppes, T, Black, DO, etal. Lower switch rate in depressed patients with bipolar II than bipolar I disorder treated adjunctively with second-generation antidepressants. Am J Psychiatry. 2006; 163(2): 313–315.CrossRefGoogle ScholarPubMed
74.Amsterdam, JD, Shults, J. Efficacy and mood conversion rate of short-term fluoxetine monotherapy of bipolar II major depressive episode. J Clin Psychopharmacol. 2010; 30(3): 306–311.CrossRefGoogle ScholarPubMed
75.Parker, G, Tully, L, Olley, A, Hadzi-Pavlovic, D. SSRIs as mood stabilizers for bipolar II disorder? a proof of concept study. J Affect Disord. 2006; 92(2–3): 205–214.CrossRefGoogle ScholarPubMed
76.Amsterdam, JD, Shults, J. Comparison of short-term venlafaxine versus lithium monotherapy for bipolar II major depressive episode: a randomized open-label study. J Clin Psychopharmacol. 2008; 28(2): 171–181.Google ScholarPubMed
77.Gijsman, HJ, Geddes, JR, Rendell, JM, etal. Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Am J Psychiatry. 2004; 161(9): 1537–1547.CrossRefGoogle ScholarPubMed
78.Sidor, MM, MacQueen, GM. Antidepressants for the acute treatment of bipolar depression: a systematic review and meta-analysis. J Clin Psychiatry. 2011; 72(2): 156–167.CrossRefGoogle ScholarPubMed
79.Tondo, L, Baldessarini, RJ, Vázquez, G, etal. Clinical responses to antidepressants among 1036 acutely depressed patients with bipolar or unipolar major affective disorders. Acta Psychiatr Scand In press. DOI: 10.1111/acps.12023.Google Scholar
80.Post, RM, Altshuler, LL, Leverich, GS, etal. Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. Br J Psychiatry. 2006; 189: 124–131.CrossRefGoogle ScholarPubMed
81.Vieta, E, Martinez-Arán, A, Goikolea, JM, etal. A randomized trial comparing paroxetine and venlafaxine in the treatment of bipolar depressed patients taking mood stabilizers. J Clin Psychiatry. 2002; 63(6): 508–512.CrossRefGoogle ScholarPubMed
82.Tondo, L, Vázquez, G, Baldessarini, RJ. Mania associated with antidepressant treatment: comprehensive meta-analytic review. Acta Psychiatr Scand. 2010; 121(6): 404–414.CrossRefGoogle ScholarPubMed
83.Undurraga, J, Baldessarini, RJ, Valenti, M, etal. Bipolar depression: clinical correlates of receiving antidepressants. J Affect Disord. 2012; 139(1): 89–93.CrossRefGoogle ScholarPubMed
84.Joffe, RT, MacQueen, GM, Marriott, M, Young, LT. One-year outcome with antidepressants-treatment of bipolar depression. Acta Psychiatr Scand. 2005; 112(2): 105–109.CrossRefGoogle Scholar
85.Altshuler, LL, Post, RM, Helleman, G, etal. Impact of antidepressants continuation after acute positive or partial treatment response for bipolar depression: a blinded, randomized study. J Clin Psychiatry. 2009; 70(4): 450–457.CrossRefGoogle ScholarPubMed
86.Ghaemi, SN, Ostacher, MM, El-Mallakh, RS, etal. Antidepressant discontinuation in bipolar depression: a Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) randomized clinical trial of long-term effectiveness and safety. J Clin Psychiatry. 2010; 71(4): 372–380.CrossRefGoogle ScholarPubMed
87.Frye, MA, Grunze, H, Suppes, T, etal. A placebo-controlled evaluation of adjunctive modafinil in the treatment of bipolar depression. Am J Psychiatry. 2007; 164(8): 1242–1249.CrossRefGoogle ScholarPubMed
88.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(3): 564–566.CrossRefGoogle ScholarPubMed
89.Zarate, CA Jr, Payne, JL, Singh, J, etal. Pramipexole for bipolar II depression: a placebo-controlled proof of concept study. Biol Psychiatry. 2004; 56(1): 54–60.CrossRefGoogle ScholarPubMed
90.Diazgranados, N, Ibrahim, L, Brutsche, NE, etal. A randomized add-on trial of N-methyl-D-aspartate antagonist in treatment-resistant bipolar depression. Arch Gen Psychiatry. 2010; 67(8): 793–802.CrossRefGoogle ScholarPubMed
91.Rybakowski, JK, Permoda-Osip, A, Skibinska, M, etal. Single ketamine infusion in bipolar depression resistant to antidepressants: are neurotrophins involved? Hum Psychopharmacol. In press. DOI: 10.1002/hup.2271.Google Scholar
92.Zarate, CA, Brutsche, NE, Ibrahim, L, etal. Replication of ketamine's antidepressant efficacy in bipolar depression: a randomized controlled add-on trial. Biol Psychiatry. 2012; 71(11): 939–946.CrossRefGoogle ScholarPubMed
93.Lu, RB, Chen, SL, Lee, SY, etal. Neuroprotective and neurogenesis agent for treating bipolar II disorder: add-on memantine to mood stabilizer works. Med Hypotheses. 2012; 79(2): 280–283.CrossRefGoogle ScholarPubMed
94.Frangou, S, Lewis, M, McCrone, P. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study. Br J Psychiatry. 2006; 188: 46–50.CrossRefGoogle ScholarPubMed
95.Keck, PE Jr, Mintz, J, McElroy, SL, etal. Double-blind, randomized, placebo-controlled trials of ethyl-eicosapentanoate in the treatment of bipolar depression and rapid cycling bipolar disorder. Biol Psychiatry. 2006; 60(9): 1020–1022.CrossRefGoogle ScholarPubMed
96.Miklowitz, DJ, Otto, MW, Frank, E, etal. Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry. 2007; 64(4): 419–426.CrossRefGoogle ScholarPubMed
97.Colom, F, Vieta, E, Martinez-Aran, A, etal. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry. 2003; 60(4): 402–407.CrossRefGoogle ScholarPubMed
98.Lam, DH, Watkins, ER, Hayward, P, etal. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry. 2003; 60(2): 145–152.CrossRefGoogle ScholarPubMed
99.Scott, J, Paykel, E, Morriss, R, etal. Cognitive-behavioural therapy for severe and recurrent bipolar disorders: randomized controlled trial. Br J Psychiatry. 2006; 188: 313–320.CrossRefGoogle Scholar
100.Miklowitz, DJ, George, EL, Richards, JA, etal. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry. 2003; 60(9): 904–912.CrossRefGoogle ScholarPubMed
101.Frank, E, Kupfer, DJ, Thase, ME, etal. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry. 2005; 62(9): 996–1004.CrossRefGoogle ScholarPubMed
102.Frank, E, Soreca, I, Swartz, HA, etal. The role of interpersonal and social rhythm therapy in improving occupational functioning in patients with bipolar I disorder. Am J Psychiatry. 2008; 165(12): 1559–1565.CrossRefGoogle ScholarPubMed
103.Dierckx, B, Heijnen, WT, van den Broek, WW, Birkenhäger, TK. Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis. Bipolar Disord. 2012; 14(2): 146–150.CrossRefGoogle ScholarPubMed
104.Grunhaus, L, Schreiber, S, Dolberg, OT, etal. Response to ECT in major depression: are there differences between unipolar and bipolar depression? Bipolar Disord. 2002; 4(suppl 1): 91–93.CrossRefGoogle ScholarPubMed
105.Medda, P, Perugi, G, Zanello, S, etal. Response to ECT in bipolar I, bipolar II and unipolar depression. J Affect Disord. 2009; 118(1–3): 55–59.CrossRefGoogle ScholarPubMed
106.Blanco, C, Laje, G, Olfson, M, etal. Trends in the treatment of bipolar disorder by outpatient psychiatrists. Am J Psychiatry. 2002; 159(6): 1005–1010.CrossRefGoogle ScholarPubMed
107.Koukopoulos, A, Albert, MJ, Sani, G, Koukopoulos, AE. Mixed depressive states: nosologic and therapeutic issues. Int Rev Psychiatry. 2005; 17(1): 21–37.CrossRefGoogle ScholarPubMed
108.Krüger, S, Young, LT, Bräunig, P. Pharmacotherapy of bipolar mixed states. Bipolar Disord. 2005; 7(3): 205–215.CrossRefGoogle ScholarPubMed
109.Swartz, HA, Frank, E, Cheng, Y. A randomized pilot study of psychotherapy and quetiapine for the acute treatment of bipolar II depression. Bipolar Disord. 2012; 14(2): 211–216.CrossRefGoogle ScholarPubMed
110.Pacchiarotti, I, Valentí, M, Bonnin, CM, etal. Factors associated with initial treatment response with antidepressants in bipolar disorder. Eur Neuropsychopharmacol. 2011; 21(5): 362–369.CrossRefGoogle ScholarPubMed
111.Pacchiarotti, I, Valentí, M, Colom, F, etal. Differential outcome of bipolar patients receiving antidepressant monotherapy versus combination with an antimanic drug. J Affect Disord. 2011; 129(1–3): 321–326.Google ScholarPubMed