2005 Goodwin and Jamison 2007 Baldessarini 2013 Yildiz et al. Tension continues between lumping mood syndromes and separating various depressive and bipolar subtypes, and considering a “spectrum” of disorders ranging from more or less pure depression to archetypical BD, leading to profound therapeutic ambiguities (Cuellar et al. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.ĭebate concerning Kraepelin’s broadly inclusive concept of manic-depressive illness (MDI) continued to 1980 with a first formal separation of a distinct bipolar disorder (BD) with mania from nonbipolar major depressive disorder (MDD) in DSM-III (Trede et al. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Lithium may reduce suicide risk in BD clozapine and ketamine require further testing. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. Depression in bipolar disorder (BD) patients presents major clinical challenges.
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