The Evidence for Antidepressant Use in Bipolar Depression
J Clin Psychiatry 2006;67(suppl 11):18-21
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Mood elevation, which includes mania, hypomania, and mixed states, was previously considered
the defining symptom of bipolar disorder, but bipolar depression by comparison is actually a much
more substantial challenge to diagnose and treat. Recent studies, including research by the Systematic
Treatment Enhancement Program for Bipolar Disorder (STEP-BD), found that patients with bipolar
disorder spend longer periods of time in depressive episodes and are more likely to relapse to depression
compared with mania or hypomania. However, the treatment of bipolar depression is hampered
by the limited number and varying quality of available studies of pharmacologic treatments to guide
clinical decision making. Clinicians should rely on studies with the highest level of evidence (category
A) when prescribing appropriate antidepressant treatments. The standard care pathways outlined
by STEP-BD to aid clinicians in treating varying phases of bipolar disorder provide data on the
use of various treatments for bipolar depression and their outcomes. While some treatments have the
potential to induce mania, others appear to have some efficacy without inducing mania.