Bipolar Depression: Specific Treatments

From the perspective of pharmacologic treatment, bipolar depression is considered in this article asbelonging to a spectrum of affective disorders. Insufficient controlled data permit only general recommendationsfor treatment of the spectrum of affective disorders, except perhaps for the classic form ofbipolar I disorder. While the field waits for prospective controlled trials, a wide range of drugs is currentlyavailable for the treatment of bipolar depression. The potential advantages of having an increasingnumber of agents with different mechanisms of actions are suggested by the many small studies claimingsome degree of advantage in one or another subgroup of patients with bipolar depression. Several antidepressantsand one anticonvulsant have the virtue of clinical experience that contributes to a body of informationabout 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 otherwisesafe, selective serotonin reuptake inhibitors are probably the most comfortable first-line treatment for bipolardepression.