Managing Bipolar Depression: Basics & Beyond

The Psychopharmacology Algorithm Project at the Harvard South Shore Program published algorithms for bipolar depression in 1999 and 2010.

Here is the summary of their recent guidelines from 2019 in the following table:

(a) For the urgent treatment of bipolar depression:

  • Electroconvulsive therapy (ECT) is still the first‐line option.

(b) For acute bipolar depression:

  • lamotrigine, lurasidone, lithium, quetiapine, and cariprazine.
  • either as single or in combination (if monotherapy fails)
  • medication choice is determined by side effects vulnerability and patient preference.

(c) If the above medications fail:

  • antidepressants (bupropion and SSRI) or
  • valproate (very small evidence‐base)

(d) In bipolar II depression:

  • the support for antidepressants is a little stronger

(e) Depression with mixed features and rapid cycling:

  • would usually lead to further postponement of antidepressants.

(f) Medication not considered beyond this point:

  • Olanzapine+fluoxetine
  • due to metabolic side effects.

REFERENCE:

  • Giakoumatos CI, Osser D. The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An Update on Unipolar Nonpsychotic Depression. Harv Rev Psychiatry. 2019 Jan/Feb;27(1):33-52. PubMed PMID: 30614886. (Pubmed)

FOR ACADEMY MEMBERS:

BIPOLAR DEPRESSION: BASICS & BEYOND

INTERESTED IN LEARNING MORE?

JOIN PSYCHIATRY EDUCATION FORUM ACADEMY MEMBERSHIP

This is a closed membership for medical professionals only.

  • 30+ Courses/Sections: Each chapter within these sections is of direct clinical relevance for your daily practice. 
  • Journal Club: we will post the most recently published psychiatry articles relevant to your daily clinical practice.
  • Coffee Club: contain short discussions with clinical experts in the field of psychiatry.
  • Clinical Case Discussions: Discussions of clinical cases from our daily clinical practice. 
  • Discussion Forum & Community: Connect with other medical professionals and discuss your difficult-to-treat clinical cases.
  • Essentials of Inpatient Psychiatry Book: All chapters from this book are included in the academy sections. 
  • Goal: is to have all important clinically relevant topics in one place for ease of access.

SUBSCRIBE TO OUR EMAIL NEWSLETTER:

Related Articles