Regarding the treatment of patients with bipolar disorder, positive findings have shown that patients engaged in treatment may live longer. Angst and Sellaro studied standardized mortality ratios for patients with bipolar disorder and found a significant reduction in mortality ratio in our bipolar patients who were actively in treatment (Slide 1). Data from the Collaborative Depression Study by Judd and colleagues showed that bipolar patients are quite symptomatic. Judd and colleagues followed bipolar patients over a 13-year period and found that these patients were symptomatic ~50% of the study period. What were these patients most likely to be symptomatic with: bipolar depression (Slide 2). Thus, it is important to focus on bipolar depression and examine placebo-controlled trials that were adequately powered in its treatment.

Over the last decade, there have been positive trials studying lamotrigine, quetiapine, olanzapine, and olanzapine-fluoxetine combination. Two of these medications are United States Food and Drug Administration—approved in bipolar disorder treatment: quetiapine and olanzapine-fluoxetine. There are a number of negative trials in bipolar depression, including a number of antidepressant monotherapy trials and antidepressants in combination with mood stabilizers (Slide 3). However, what is the most frequent pharmacotherapy treatment used for bipolar depression? It is the use of antidepressants alone; antidepressant monotherapy is twice as commonly prescribed as mood stabilizers (Slide 4). Thus, it is necessary for clinicians to possess knowledge of the evidence and results from both positive and negative antidepressant trials for bipolar disorder.