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Pharmacological Treatment of Bipolar Depression: What are the Current and Emerging Options?

Authors Yalin N, Young AH

Received 8 January 2020

Accepted for publication 15 April 2020

Published 9 June 2020 Volume 2020:16 Pages 1459—1472

DOI https://doi.org/10.2147/NDT.S245166

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Roger Pinder


Nefize Yalin, Allan H Young

Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK

Correspondence: Allan H Young
Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
Tel +020 78485895
Fax +020 78480298
, Email allan.young@kcl.ac.uk

Abstract: Depression accounts for the predominant burden associated with bipolar disorder. The identification and management of bipolar depression are challenging, since bipolar depression differs from unipolar depression, responding poorly to traditional antidepressants, which may also induce a switch to hypomania/mania, mixed states and/or cause rapid cycling. Current treatment options for bipolar depression are limited and guidelines vary greatly in their recommendations, reflecting gaps and inconsistencies in the current evidence base. Moreover, some treatment options, such as quetiapine and olanzapine–fluoxetine, although clearly efficacious, may be associated with adverse cardiometabolic side effects, which can be detrimental to the long-term physical health and well-being of patients, increasing the likelihood of treatment non-adherence and relapse. Evidence for some more recent therapeutic options, including lurasidone and cariprazine, suggests that patients’ symptoms can be effectively managed without compromising their physical health. In addition, novel agents targeting alternative neurotransmitter pathways and inflammatory processes (such as ketamine and N-acetyl cysteine) are emerging as promising potential options for the treatment of bipolar depression in the future.

Keywords: antidepressant, atypical antipsychotic, bipolar depression, bipolar disorder, pharmacotherapy

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