Bipolar Disorder Health Center

Treating Bipolar Depression

Depression with bipolar disorder has a negative impact on the lives of millions. Yet treatment for bipolar depression has come a long way from when patients were drugged with heavy, sedating tranquilizers just a few decades ago. Today, the mainstay of treatments for bipolar disorder may include mood stabilizing drugs. These include drugs such as lithium, or an antipsychotic medication, or a combination of these medications -- all with the goal of modulating moods without igniting a manic episode.

While depression episodes are far more common than mania and have a tremendous effect on the lives of patients, few studies are available on understanding bipolar depression and how it is best treated.

What's the standard treatment for bipolar depression?

According to the second edition of the American Psychiatric Association's practice guidelines, first-line medication therapy for acute depression in patients with bipolar disorder is either lithium or the anticonvulsant lamotrigine. Both lithium and lamotrigine are mood stabilizers. For severely ill patients lithium and an antidepressant are sometimes used.

A mood-stabilizing medication works on improving social interactions, mood, and behavior and is recommended for both treatment and prevention of bipolar mood states that swing from the lows of depression to the highs of hypomania or mania. According to the American Psychiatric Association (APA), lithium, lamotrigine, valproate, carbamazepine, and most atypical antipsychotic medications are approved by the FDA for treating one (or more) phases of bipolar disorder.

In some patients with bipolar disorder, a mood stabilizer may be all that's needed to modulate the depressed mood. However, in bipolar patients who do not respond to one mood stabilizer, another mood stabilizer or an atypical antipsychotic should be added to the treatment regimen.

Are antidepressants used to treat bipolar depression?

While antidepressants are effective treatment for major depression, antidepressants should not be given alone (monotherapy) with bipolar depression. When antidepressants are given alone to someone with bipolar disorder, there's a risk the drug might ignite a manic episode in some patients. Knowing this, most doctors may avoid using antidepressants as monotherapy for bipolar depression.

Using mood stabilizers instead of antidepressants to treat bipolar depression is supported by the STEP-BD study - the largest study of its kind that continues to evaluate all the best-practice treatment modalities used for people with bipolar disorder, including the use of mood-stabilizing medications, antidepressants, atypical antipsychotics, and psychosocial interventions.