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Treatment Options for Bipolar Depression

Charles L. Bowden , MD

Published: January 15, 2005

Article Abstract

Bipolar disorder is often misdiagnosed as major depressive disorder because of the high frequencyof depressive symptomatology in many patients with bipolar disorder. Depressive episodes that areresistant to treatment may also be associated with a worse course of illness in bipolar disorder, but wedo not yet understand all the factors in the connection between bipolar disorder and depression. Thedata on the effectiveness of antidepressants in the treatment of depression in bipolar disorder varygreatly, and there have been few prospective, randomized studies on the subject. From the data so far,the rates of induction of mania for selective serotonin reuptake inhibitors and lamotrigine seem similarto those seen with placebo. The optimal length of time to continue antidepressant treatment in patientswith bipolar disorder has not yet been determined; however, research tends to indicate that alonger term of treatment (6 months or more) may aid in the prevention of relapse. Newer U.S. Foodand Drug Administration-approved treatments for depression in bipolar disorder include a combinationof olanzapine and fluoxetine, which is used for depressive episodes in bipolar disorder, and lamotrigine,which is used for maintenance treatment of bipolar I disorder. Psychoeducation has also beenexamined as a possible treatment for depression in bipolar disorder, and a study has shown that patientsreceiving psychoeducation plus medication may have a lower rate of relapse than patients whoreceive medication alone.

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