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Bipolar Depression: Best Practices for the Hospitalized Patient

  • Paul E. Keck, Mark A. Frye and Michael E. Thase


One of the most challenging clinical topics in psychiatry is the diagnosis and treatment of bipolar depression. The term mood stabilizer is frequently employed in the treatment of the hospitalized bipolar patient, although clinicians do not universally agree on a consensus definition of this term. Most clinicians would agree that a mood stabilizer refers to a medication that is effective for the acute treatment of manic, mixed, hypomanic, or depressive episodes. Many experts agree that such treatment should offer efficacy against mania, should not worsen depression, and preferably should treat depression as well. In addition, the acute effectiveness in stabilization should not be at the expense of inducing alternate mood symptoms or switching the patient into the alternate phase of illness. From a maintenance standpoint, a mood stabilizer should also prevent against future relapse or recurrence of manic, mixed, hypomanic, or depressive symptoms or episodes (Slide 1).

In addition to use of mood stabilizers, there are other issues surrounding treatment of the hospitalized patient with bipolar depression, including the commonly comorbid issue of substance abuse. Hazardous drinking may more commonly occur in bipolar depression or depressive phase of illness, representing a more complex clinical picture. To facilitate understanding of this complex disorder and its appropriate treatment, this discussion centers around the case of a major depressive episode in a patient with a past history of of mania (ie, bipolar I depression or bipolar depression).



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1.McKowen, JW, Frye, MA, Altshuler, LL, Gitlin, MJ. Patterns of alcohol consumption in bipolar patients comorbid for alcohol abuse or dependence. Bipolar Disord. 2005;7(4):377381.
2.Goodwin, FK, Jamison, KR. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression. 2nd ed. Oxford, England: Oxford University Press; 2007.
3.Abulseoud, O, et al.J Dual Diagn. 2007. In press.
4.Judd, LL, Akiskal, HS, Schettler, PJ, et al.Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study. Arch Gen Psychiatry. 2005,62(12):13221330.
5.Schretlen, DJ, Cascella, NG, Meyer, SM, et al.Neuropsychological functioning in bipolar disorder and schizophrenia, Biol Psychiatry. 2007;62(2):179186.
6.Otto, MW, Simon, NM, Wisniewski, SR, et al, and the STEP-BD Investigators. Prospective 12-month course of bipolar disorder in out-patients with and without comorbid anxiety disorders. Br J Psychiatry. 2006;189:2025.
7.Tohen, M, Vieta, E, Calabrese, J, et al.Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry. 2003;60(11):10791088.
8.Calabrese, JR, Keck, PE Jr, Macfadden, W, et al.A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. Am J Psychiatry. 2005;162(7):13511360.
9.Thase, ME, Macfadden, W, Weisler, RH, et al, and the BOLDER II Study Group. Efficacy of quetiapine monotherapy in bipolar I and II depression: a double-blind, placebo-controlled study (the BOLDER II study). J Clin Psychopharmacol. 2006;26(6):600609.
10.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
11.Reoux, JP, Saxon, AJ, Malte, CA, Baer, JS, Sloan, KL. Divalproex sodium in alcohol withdrawal: a randomized double-blind placebo-controlled clinical trial. Alcohol Clin Exp Res. 2001;25(9):13241329.
12.Salloum, IM, Cornelius, JR, Daley, DC, Kirisci, L, Himmelhoch, JM, Thase, ME. Efficacy of valproate maintenance in patients with bipolar disorder and alcoholism: a double-blind placebo-controlled study. Arch Gen Psychiatry. 2005;62(1):3745.
13.Weiss, RD, Griffin, ML, Greenfield, SF, et al.Group therapy for patients with bipolar disorder and substance dependence: results of a pilot study. J Clin Psychiatry. 2000;61(5):361367.

Bipolar Depression: Best Practices for the Hospitalized Patient

  • Paul E. Keck, Mark A. Frye and Michael E. Thase


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