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Important Distinctions Between Bipolar I and Bipolar II Depression

Terence A. Ketter, MD

Published: August 15, 2013

Article Abstract

Patients with bipolar disorder can spend up to half of their time with depressive symptoms, yet current bipolar depression treatments are limited. A crucial challenge for clinicians selecting treatments is to reconcile patient preferences with efficacy and tolerability profiles of available agents. Treatment selection can be facilitated using the number needed to treat (NNT), which measures efficacy, and the number needed to harm (NNH), which measures tolerability. Certain older second-generation antipsychotics (quetiapine monotherapy and the olanzapine plus quetiapine combination) can be effective for bipolar depression, but their clinical utility is commonly limited by side effects. Antidepressants and certain mood stabilizers (lithium and lamotrigine) have adequate tolerability, but their efficacy in bipolar depression is limited or remains to be firmly established. To achieve optimal results, clinicians need to select treatments by balancing the needs for efficacy (based on clinical urgency of depressive symptoms) and tolerability by integrating patient preferences regarding such balance.

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