Psychiatria pre prax 1/2012

Acute treatment of bipolar depression

In the last years new data have been published on the acute treatment of depression of bipolar affective disorder. They have been subsequently involved in the guidelines and treatment algorithms of bipolar affective disorder. Unfortunately, they often led to conflicting conclusions and recommendations due to limitations of the available literature. As a general approach during depressive episodes in bipolar disorder most guidelines suggest lithium, lamotrigine or quetiapine monotherapy as first-line choice. If psychotic features are present, to add an antipsychotic such as olanzapine, quetiapine or risperidone. The use of an antidepressant with caution, always in combination with quetiapine, lamotrigine or mood stabilizer. Although guidelines cannot substitute professional knowledge and clinical judgement, they might be a useful tool for clinicians in order to orientate their practice towards evidence base.

Keywords: bipolar depression, guideline, lamotrigine, treatment, lithium, olanzapine, quetiapine, review, valproate.