Bipolar Depression: Specific Treatments

From the perspective of pharmacologic treatment, bipolar depression is considered in this article as belonging to a spectrum of affective disorders. Insufficient controlled data permit only general recommendations for treatment of the spectrum of affective disorders, except perhaps for the classic form of bipolar I disorder. While the field waits for prospective controlled trials, a wide range of drugs is currently available for the treatment of bipolar depression. The potential advantages of having an increasing number of agents with different mechanisms of actions are suggested by the many small studies claiming some degree of advantage in one or another subgroup of patients with bipolar depression. Several antidepressants and one anticonvulsant have the virtue of clinical experience that contributes to a body of information about side effects and the potential for producing benefit in at least some bipolar depressed patients. By default, and because they appear to have less chance of precipitating mania and are otherwise safe, selective serotonin reuptake inhibitors are probably the most comfortable first-line treatment for bipolar depression.