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Bipolar Disorder Treatment Overview

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Depression in Bipolar Disorder

Treating bipolar depression is controversial and challenging. Studies have shown that antidepressants may be less effective in treating bipolar depression than they are in treating depression that is not part of bipolar disorder. Also using antidepressants alone may trigger a manic or hypomanic episode in some people with bipolar disorder. 

Antidepressants alone also may lead to or prolong rapid cycling. In rapid cycling, a person may recover more quickly from depression but then experience mania followed by another episode of depression. And antidepressants can increase the risk of suicidal thoughts and attempts in children and adolescents with any form of depression.   

Three drugs are FDA-approved for the treatment of bipolar depression: Seroquel by itself, Zyprexa when used with Prozac, and Latuda used alone or with lithium or Depakote. 

There are also a number of treatments that have begun to show promise in research studies for treating bipolar depression, including the Parkinson's disease drug Mirapex, the wakefulness drugs Provigil and Nuvigil, intravenous ketamine, and a drug sometimes used to treat multiple sclerosis called riluzole.

In April 2002, the American Psychiatric Association suggested using lithium or the anticonvulsant drug Lamictal as an initial treatment for people in the acute depressive phase of bipolar disorder who were not already taking a mood-stabilizing drug. Since then, research has shown that Lamctal seems to be more effective at preventing future depression rather than treating current depression in bipolar disorder. Recent studies have shown that Lamictal added to lithium may be a potent treatment for acute bipolar depression.

For more severely ill patients, some doctors prescribe lithium and an antidepressant -- usually either Wellbutrin or an SSRI (selective serotonin reuptake inhibitor) such as Prozac or Zoloft.

If all else fails, or if symptoms are especially severe, doctors may recommend electroconvulsive therapy (ECT). It helps nearly 75% of the patients who are given this treatment. Two treatments called vagus nerve stimulation (VNS) and repetitive transcranial magnetic stimulation (rTMS) are also being studied as a treatment for bipolar depression.

In addition, psychotherapy may be beneficial when added to drug treatment. Once depression has resolved, mood stabilizers are the best treatments to prevent future depression. If psychotic symptoms occur during an acute depressive episode, the doctor may recommend antipsychotic medicine.

Nondrug treatments -- such as psychotherapy and establishing a well-ordered routine -- may help patients in their maintenance phase. They are often suggested along with medication. Psychotherapy alone is not enough to treat bipolar depression unless symptoms are mild. 

WebMD Medical Reference

Reviewed by Joseph Goldberg, MD on September 11, 2014
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