Academic journal article Current Psychiatry

Treatment of Bipolar Depression: Lessons Form Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

Academic journal article Current Psychiatry

Treatment of Bipolar Depression: Lessons Form Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

Article excerpt

Because patients with bipolar disorder spend about two-thirds of their symptomatic time in the depressed phase, accurate diagnosis of bipolar depression is a vital first step to initiating appropriate treatment. (1) However, similarity in the presentation of bipolar depression and major depressive disorder (MDD) substantially complicates the diagnostic process. (2), (3)

In addition to diagnosis, treatment selection for bipolar depression remains challenging. Although antidepressants can be a rational choice for some patients with bipolar depression, results from a 2007 randomized, double-blind, placebo-controlled, multicenter study included in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial revealed that when added to a mood stabilizer, antidepressants were no more efficacious in the treatment of bipolar disorder than a mood stabilizer alone (Figure 1). (4) Further, some patients with bipolar disorder may also experience an affective switch to a manic or mixed state while undergoing treatment with antidepressants. (3), (5)

Many clinicians frequently use antidepressants for the treatment of "depression," without ascertaining whether the major depressive episode is

due to MDD or bipolar disorder, and despite the fact that none of the antidepressants approved by the United States (US) Food and Drug Administration (FDA) to treat MDD have received an indication for bipolar depression. (4)

Appropriate Treatment of Bipolar Depression

Until June 2013 when lurasidone was approved for bipolar depression, only quetiapine and the combination of olanzapine and fluoxetine were indicated for the treatment of bipolar depression (Table 1). (6)-(11)

A Continuing Challenge

Despite the results of the STEP-BD study, the use of antidepressants off-label in patients with bipolar depression contin-ues. (12) A 2013 case-based survey of 200 US--based psychiatrists reported that 54% would prescribe antidepressant monotherapy for patients with depression, even if these patients had a family history of bipolar disorder. …

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