Pharmacological Treatment of Acute Bipolar Depression

  • Gary S. SachsEmail author
Part of the Milestones in Drug Therapy book series (MDT)


Controversy regarding management of the acute phase of bipolar depression largely reflects the natural divergence of opinions arising from large gaps in knowledge and the fact that no medication is particularly effective in this population. While there remains a great need for more and better evidence from high-quality studies to close the gaps, the past decade has seen the publication of a substantial number of fully powered placebo-controlled trials for bipolar depression, including several new agents. This chapter addresses the challenges of treating bipolar depression by describing a general schema consisting of principles for iterative personalized care that can be applied to an evolving knowledge base. This chapter also reviews the state of the evidence supporting various pharmacological treatments for bipolar depression, including quetiapine, lurasidone, lamotrigine, olanzapine, olanzapine plus fluoxetine (OFC), modafinil, armodafinil, lithium, valproate, carbamazepine, ketamine, N-acetyl cysteine (NAC), inositol, pramipexole, riluzole, and standard antidepressants, among others. Currently, five medications are supported by Category A criteria. In order of the strength of support evidence, these are quetiapine, lurasidone, olanzapine, OFC, and lamotrigine. Regardless of whether patients accept these treatments or begin with alternatives, a measurement-based approach to treatment provides a systematic means of working toward an optimized individual treatment plan.


Bipolar disorder Bipolar depression Treatment Mood stabilizer Antidepressant 


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© Springer International Publishing Switzerland (outside the USA)  2016

Authors and Affiliations

  1. 1.Bipolar Clinic and Research Program, Massachusetts General HospitalBostonUSA

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