Pharmacological Treatment Strategies for Acute Bipolar Depression

Se Joo Kim

doi:10.4306/jknpa.2018.57.4.287

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Kim: Pharmacological Treatment Strategies for Acute Bipolar Depression

Special Article

Recent Advances in the Understanding and Treatment of Bipolar Disorders

Journal of Korean Neuropsychiatric Association 2018; 57(4): 287-300.

Published online: 27 November 2018

DOI: https://doi.org/10.4306/jknpa.2018.57.4.287

Pharmacological Treatment Strategies for Acute Bipolar Depression

Se Joo Kim, MD, PhD

Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.

Address for correspondence: Se Joo Kim, MD, PhD. Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel +82-2-2228-1627, Fax +82-2-313-0891, kimsejoo@yuhs.ac

Received 8 October 2018 Revised 24 October 2018 Accepted 7 November 2018

Korean Neuropsychiatric Association

Abstract

Of the different phases of bipolar disorder, bipolar depression is more prevailing and is more difficult to treat. However, there is a deficit in systemic research on the pharmacological treatment of acute bipolar depression. Therefore, consensuses on the pharmacological treatment strategies of acute bipolar depression has yet to be made. Currently, there are only three drugs approved by the Food and Drug Administration for acute bipolar depression : quetiapine, olanzapine-fluoxetine complex, and lurasidone. In clinical practice, other drugs such as mood stabilizers (lamotrigine, lithium, valproate) and/or the other atypical antipsychotics (aripiprazole, risperidone, ziprasidone) are frequently prescribed. There remains controversy on the use of antidepressants in bipolar depression. Here, we summarized the evidence of current pharmacological treatment options and reviewed treatment guidelines of acute bipolar depression from recently published studies.

Keywords: Acute bipolar depression, Treatment guideline, Atypical antipsychotics, Mood stabilizers, Antidepressants

Figures and Tables

Fig. 1

The International College of Neuro-Psychopharmacology treatment guidelines for bipolar disorder in adults (CINP-BD-2017) : bipolar depression. Adapted from Fountoulakis, et al. Int J Neuropsychopharmacol 2017;20:180-195.30) ECT : Electroconvulsive therapy, FEWP : Free and easy wanderer plus, L-T₄ : L-thyroxine, Li : Lithium, MS : Mood stabilizer, OFC : Olanzapine-fluoxetine combination, TMS : Transcranial magnetic stimulation.

Fig. 2

Canadian Network for Mood and Anxiety Treatments and International Society for Bipolar Disorders 2018 guidelines for the management of patients with bipolar disorder (CANMAT-ISBD 2018) : acute bipolar I depression. Adapted from Yatham, et al. Bipolar Disord 2018;20:97-170.6) adj : Adjunctive, DVP : Divalproex, ECT: Electroconvulsive therapy, Li : Lithium, MAOI : Monoamine oxidase inhibitor, OFC : Olanzapine-fluoxetine combination, rTMS : Repetitive transcranial magnetic stimulation, SNRI : Serotonin norepinephrine reuptake inhibitor, SSRI : Selective serotonin reuptake inhibitor.

Table 1

British Association for Psychopharmacology guideline 2016 : bipolar depression

Adapted from Goodwin, et al. J Psychopharmacol 2016;30:495-553.88)

Table 2

Korean medication algorithm for bipolar disorder 2018 : depressive episode

ECT can be applied based on a clinician's decision at anytime. Reproduced from Seo, et al. Mood Emot 2018;16:57-68.22) AAP : Atypical antipsychotics, AD : Antidepressant, ECT : Elctroconvulsive therapy, LMT : Lamotrigine, MS : Mood stabilizer, NR : No response, PR : Partial response, rTMS : Repetitive transcranial magnetic stimulation

Notes

^{Conflicts of Interest} The author has no financial conflicts of interest.

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