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Evidence-based treatment of bipolar depression 

Evidence-based treatment of bipolar depression
Evidence-based treatment of bipolar depression

Mark A. Frye

, Paul E. Croarkin

, Marin Veldic

, Malik M. Nassan

, Katherine M. Moore

, Simon Kung

, Susannah J. Tye

, William V. Bobo

, and Jennifer L. Vande Voort

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date: 25 October 2021

Despite the predominant illness burden, evidence-based treatment, and by extension regulatory approved, for acute bipolar depression is significantly less than evidence bases in acute mania and maintenance treatment. Complicating this deficit has been persistent use of unimodal antidepressant therapy without clear and convincing benefit. Successful regulatory-approved drug development has focused on atypical antipsychotic therapy. Evidence-based treatments also include lamotrigine and divalproex by meta-analyses and a number of manual-based psychotherapies. In contrast, unimodal antidepressants as a class for bipolar depressed patients as a group appear to provide substantial benefit and may pose risk for mood destabilization. Promising novel and neuromodulatory treatments while encouraging require further systematic investigation. Understanding unimodal antidepressant response and risk patterns in bipolar disorder has immediate clinical implications. Moreover, evidence-based guidelines will need to bridge more individualized or precision-based treatment interventions.

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