Challenges in the Management of Bipolar Depression
J Clin Psychiatry 2005;66(suppl 5):11-16
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Bipolar depression has started to receive more attention in clinical trials only relatively recently,
despite the fact that patients spend more time in the depressed phase than in the manic phase of bipolar
disorder. The diagnosis and management of bipolar depression are challenging, and many patients are
undiagnosed or misdiagnosed due to symptom similarities with unipolar depression or other illnesses
and/or comorbidities. Untreated or inappropriately treated bipolar depression adds to the burden of
illness and is associated with a greater risk of suicide. Treatment options include lithium, lamotrigine,
atypical antipsychotics, and traditional antidepressants, such as the selective serotonin reuptake inhibitors.
However, traditional antidepressants are recommended with caution due to their potential risk of
switching patients into mania. Some atypical antipsychotics have shown efficacy in bipolar depression,
although longer-term studies are warranted. The choice of treatment for different subgroups of
patients with bipolar depression, including those with comorbid anxiety, may vary and also needs further
study. Other important issues that require further investigation include the recognition of the core
features of bipolar depression and the threshold symptoms for treatment, as well as the optimal treatment
choices for monotherapy or combination therapy, and acute versus long-term management of