This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions.


Evaluation and Management of Breakthrough Depressive Episodes

Paul E. Keck, Jr., MD

Published: June 1, 2004

Article Abstract

Clinicians are faced with a diagnostic challenge when a bipolar patient reports breakthrough depressivesymptomatology. Breakthrough depressive symptoms during treatment for a bipolar depressiveepisode may be a manifestation of recurrent bipolar depression or the emergence of a mixed episode.Treatment of recurrent bipolar depression and mixed episodes differs considerably, andantidepressant therapy during a mixed episode can worsen the episode and initiate or exacerbate rapidcycling. Therefore, accurate diagnosis and appropriate treatment are imperative to achieving a positiveoutcome. Research indicates that optimizing the current mood stabilizer therapy or adding anothermood stabilizer may be the best treatment options for patients with a history of rapid cycling—in patients without a history of rapid cycling, adding an antidepressant to a mood stabilizer may beless risky and therefore a reasonable choice. Combination therapy with a mood stabilizer and an atypicalantipsychotic may also be effective in managing bipolar depressive episodes.

Some JCP and PCC articles are available in PDF format only. Please click the PDF link at the top of this page to access the full text.

Related Articles

Volume: 65

Quick Links: