J Korean Neuropsychiatr Assoc.  2018 Nov;57(4):287-300. 10.4306/jknpa.2018.57.4.287.

Pharmacological Treatment Strategies for Acute Bipolar Depression

• Kim SJ

• KMID: 2426857
• DOI: http://doi.org/10.4306/jknpa.2018.57.4.287

Abstract

Of the different phases of bipolar disorder, bipolar depression is more prevailing and is more difficult to treat. However, there is a deficit in systemic research on the pharmacological treatment of acute bipolar depression. Therefore, consensuses on the pharmacological treatment strategies of acute bipolar depression has yet to be made. Currently, there are only three drugs approved by the Food and Drug Administration for acute bipolar depression : quetiapine, olanzapine-fluoxetine complex, and lurasidone. In clinical practice, other drugs such as mood stabilizers (lamotrigine, lithium, valproate) and/or the other atypical antipsychotics (aripiprazole, risperidone, ziprasidone) are frequently prescribed. There remains controversy on the use of antidepressants in bipolar depression. Here, we summarized the evidence of current pharmacological treatment options and reviewed treatment guidelines of acute bipolar depression from recently published studies.

Keyword

Acute bipolar depression; Treatment guideline; Atypical antipsychotics; Mood stabilizers; Antidepressants

MeSH Terms

Antidepressive Agents
Antipsychotic Agents
Bipolar Disorder*
Consensus
Lithium
Lurasidone Hydrochloride
Quetiapine Fumarate
Risperidone
United States Food and Drug Administration
Antidepressive Agents
Antipsychotic Agents
Lithium
Lurasidone Hydrochloride
Quetiapine Fumarate
Risperidone

Figure

• 

  Fig. 1 The International College of Neuro-Psychopharmacology treatment guidelines for bipolar disorder in adults (CINP-BD-2017) : bipolar depression. Adapted from Fountoulakis, et al. Int J Neuropsychopharmacol 2017;20:180-195.30) ECT : Electroconvulsive therapy, FEWP : Free and easy wanderer plus, L-T4 : L-thyroxine, Li : Lithium, MS : Mood stabilizer, OFC : Olanzapine-fluoxetine combination, TMS : Transcranial magnetic stimulation.

• 

  Fig. 2 Canadian Network for Mood and Anxiety Treatments and International Society for Bipolar Disorders 2018 guidelines for the management of patients with bipolar disorder (CANMAT-ISBD 2018) : acute bipolar I depression. Adapted from Yatham, et al. Bipolar Disord 2018;20:97-170.6) adj : Adjunctive, DVP : Divalproex, ECT: Electroconvulsive therapy, Li : Lithium, MAOI : Monoamine oxidase inhibitor, OFC : Olanzapine-fluoxetine combination, rTMS : Repetitive transcranial magnetic stimulation, SNRI : Serotonin norepinephrine reuptake inhibitor, SSRI : Selective serotonin reuptake inhibitor.

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