Academic journal article Current Psychiatry

Are You Up to Date? Latest Guidance for Evidence-Based Treatment for Bipolar Depression

Academic journal article Current Psychiatry

Are You Up to Date? Latest Guidance for Evidence-Based Treatment for Bipolar Depression

Article excerpt


LATUDA is indicated for the treatment of major depressive episodes associated with bipolar I disorder (bipolar depression) as monotherapy and as adjunctive therapy with lithium or valproate in adults.


The effectiveness of LATUDA for longer-term use, that is, for more than 6 weeks, has not been established in controlled studies. Therefore, the physician who elects to use LATUDA for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient. The efficacy of LATUDA in the treatment of mania associated with bipolar disorder has not been established.

IMPORTANT SAFETY INFORMATION AND INDICATIONS FOR LATUDA Antidepressants increased the risk compared to placebo of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior in patients over age 24. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. LATUDA is not approved for use in pediatric patients with depression.

A multidisciplinary panel of clinical experts contributed to the development of this 3-part newsletter series. Each issue explores strategies for the management of patients with bipolar disorder and features expert commentary from the psychiatry, primary care, or nurse-practitioner/ physician-assistant perspective.

A Need for Guidance

Early and accurate diagnosis of the condition underlying depressive episodes is essential for appropriate treatment of patients.1 Specifically, it is important to recognize the depressive episodes associated with bipolar I disorder--which we also know as bipolar depression--and differentiate it from other forms of depression, such as those associated with general medical conditions, substance use, or major depressive disorder (MDD), according to Henry A. Nasrallah, MD (1)

Although no antidepressant is approved by the United States (US) Food and Drug Administration (FDA) as monotherapy for the treatment of bipolar disorder and there is limited evidence of efficacy, antidepressants are commonly used treatments for this serious mental illness. (2-4) Labeling any and all depressive symptoms as "depression" potentially perpetuates this longstanding practice trend, opines William Clay Jackson, MD, DipTh, FAAFP He points to a study of 649 primary care patients receiving antidepressants for "treatment of depression" between April 2003 and March 2004 in which 21.3% of the patients screened positive for bipolar disorder. (5) Consistent with Dr. Nasrallah's statement above about differentiating the condition underlying a patient's depressive episodes, Dr. Jackson says that referring to depressive symptoms as simply "depression" rather than specifying which disorder is driving them may lead clinicians to incorrectly generalize all symptoms of depression as MDD.

A 2013 study examining practice patterns of US psychiatrists suggests that, even when a diagnosis of bipolar disorder is considered, patients may still receive antidepressants. Glauser and colleagues reported that more than one-half of the 200 psychiatrists surveyed indicated that they would prescribe antidepressant monotherapy for patients with symptoms of depression and a family history of bipolar disorder. (6)

The importance of a precise diagnosis cannot be overstated, especially when it comes to unipolar and bipolar depression, because an accurate diagnosis can guide the prescription of appropriate treatment, say Susan L. …

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