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Cited by 89Bipolar Disorder and TreatmentTreatment of Major DepressionPersonality Disorders and Psychopathology

Bipolar depression: issues in diagnosis and treatment

Thase, Michael E.·2005·Harvard Review of Psychiatry
DOI 10.1080/10673220500326425
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Abstract

Although bipolar affective disorder is defined by the history of manic or hypomanic episodes, depression is arguably a more important facet of the illness. Depressive episodes, on average, are more numerous and last longer than manic or hypomanic episodes, and most suicides occur during these periods. Misdiagnosis of major depressive disorder delays initiation of appropriate therapy, further worsening prognosis. Distinguishing features of bipolar depression include earlier age of onset, a family history of bipolar disorder, presence of psychotic or reverse neurovegetative features, and antidepressant-induced switching. Bipolar I depressions should initially be treated with a mood stabilizer (carbamazapine, divalproex, lamotrigine, lithium, or an atypical antipsychotic); antidepressant monotherapy is contraindicated. More severe or "breakthrough" episodes often require a concomitant antidepressant, such as bupropion or a selective serotonin reuptake inhibitor (SSRI). The first treatment specifically approved for bipolar depression is a combination of the SSRI fluoxetine and the atypical antipsychotic olanzapine. For refractory depressive episodes, venlafaxine, the monoamine oxidase inhibitor tranylcypromine, and ECT are most widely recommended. The optimal duration of maintenance antidepressant therapy has not been established empirically and, until better evidence-based guidelines are established, should be determined on a case-by-case basis.

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  • SSRIs and mood stabilizers can have opposing therapeutic actions in bipolar patients.

    “Interestingly, SSRIs and mood stabilizers can have opposing therapeutic actions in bipolar patients (Thase, 2005).”

    From Circadian genes, rhythms and the biology of mood disorders (2007) · cites this paper as Thase, 2005

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Authors
Thase, M. E.
Affiliations
University of Pittsburgh Medical Center (US)
Corresponding author
Thase, Michael E.
Venue
Harvard Review of Psychiatry
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2005-09
Volume
13
Issue
5
Pages
257-271
ISSN
1067-3229 (ISSN-L)
DOI
10.1080/10673220500326425
OpenAlex
W2077806570
Cited by
89
References
149
Citations by year
2026: 2 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 4 · 2014: 3 · 2013: 2 · 2012: 6
FWCI
1.42
Type
journal article
Language
en
Open access
closed
Locations
  • Harvard Review of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (MH80001)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
bipolar depression, bipolar disorder, mood stabilizers, lithium, lamotrigine, divalproex, atypical antipsychotics, bupropion, selective serotonin reuptake inhibitors, venlafaxine, tranylcypromine, electroconvulsive therapy, treatment-resistant depression, suicide
MeSH terms
Antidepressive Agents, Bipolar Disorder, Depressive Disorder, Major, Major Depressive Disorder, Diagnosis, Differential, Drug Therapy, Combination, Humans, Prognosis, Antipsychotic Agents, Antimanic Agents

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