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Treating Bipolar Depression

Treatment for bipolar depression has come a long way from the days (not so long ago) when patients were given sedatives and medications with numerous side effects. Today, mood stabilizing drugs are a mainstay treatment for bipolar disorder.  Doctors may prescribe lithium, an antimanic drug, or an antipsychotic drug -- or a combination of both -- in order to alleviate symptoms of depression without triggering a manic episode.

While depression episodes are far more common than manias and have a tremendous effect on the lives of patients, there are only a few established treatments for bipolar depression.

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Warning Signs and Symptoms of Bipolar Disorder

People with bipolar disorder often have cycles of elevated and depressed mood that fit the description of "manic depression." When a person's illness follows this classic pattern, diagnosing bipolar disorder is relatively easy. But bipolar disorder can be sneaky. Symptoms can defy the expected manic-depressive sequence. Infrequent episodes of mild mania can go undetected. Depression can overshadow other aspects of the illness. And substance abuse can cloud the picture. Taken together, these factors...

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What's the standard treatment for bipolar depression?

Lithium and the anticonvulsants lamotrigine and valproate are treatments for bipolar depression. They 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 can be added to the treatment regimen.

Are antidepressants used to treat bipolar depression?

While antidepressants are effective treatment for people with major depressive (unipolar) disorder, antidepressants are not always as effective for bipolar depression, and generally should not be given alone (monotherapy) in people with bipolar I disorder.  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. It evaluated the best-practice treatment for people with bipolar disorder, including the use of mood-stabilizing medications, antidepressants, atypical antipsychotics, and psychosocial interventions. That study found that adding an antidepressant to a mood stabilizer was no more effective than using a mood stabilizer alone to treat bipolar depression.  However, recovery was seen in only about 1 in 4 people in either treatment group, underscoring the importance of other treatments than mood stabilizers or antidepressants for treating bipolar depression.

 

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