Feature Article

Bipolar disorder: focus on depression

Philip B Mitchell, Bronwyn Gould
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Patients with bipolar disorder spend more of their lives in depressed mood than in elevated mood, even though mania is the distinguishing feature of this condition. It is these depressive episodes that are associated with the marked disability and the high suicide rates linked to this disorder.

Key Points

  • Patients with bipolar disorder spend more of their lives in depressed than elevated mood. The marked disability and high suicide rates linked to bipolar disorder are associated with these depressive episodes.
  • There is concern that bipolar disorder, and particularly bipolar II disorder, may be becoming overdiagnosed.
  • Patients with bipolar disorder that is not severe or is very treatment-responsive can be managed by GPs, with psychiatrists providing occasional clinical review and ‘back-up’ when complications or major recurrences occur.
  • There is evidence for the use in acute bipolar depression of lamotrigine, lithium, olanzapine (particularly in conjunction with fluoxetine) and quetiapine.
  • Definite preventive effects against bipolar depression have been demonstrated for lamotrigine, lithium, olanzapine and quetiapine (in conjunction with lithium and sodium valproate).
  • Although evidence is conflicting regarding the efficacy of antidepressants in bipolar depression and their tendency to induce mania or rapid cycling, the authors consider they have a valid role when they are used in conjunction with appropriate preventive therapy (i.e. mood stabilisers).
  • Cognitive behavioural therapy, psychoeducation and interpersonal and social rhythms therapy have been shown to be of value in bipolar depression.