The recent presentation that I gave at UCSF on this topic allowed me to review all of the controlled clinical trials related to the treatment of bipolar depression.
In a follow-up post I plan on talking about some of the exciting new developments that suggest that we will soon, and to some extent do already, have some very promising approaches to treatment for this serious and difficult to treat problem. Today I want to set the stage for that by talking about the the challenges that are in everyday reality for those of us who treat people with bipolar depression.
Terry Ketter, one of the most widely regarded international experts on bipolar disorder and its pharmacologic treatment, put together a CME program in the last few months on the topic, and I thought the video clip below, from that program, neatly illustrates the dilemmas.
There are a very limited number of treatments for this condition and those that do exist all have significant, potentially serious, side effects.
The issue of side effects was neatly illustrated by an informal poll I took of those attending the presentation. There are three FDA approved treatments for acute bipolar depression: fluoxetine plus olanzapine (OFC), quetiapine, and lurasidone. I asked the audience how many had prescribed the most effective (based on the clinical trial data) of these, and nobody raised their hand.
The most treatment is OFC, but serious issues with weight gain and other side effects make it a rarely used treatment.
Next time I will write about some options supported by smaller clinical trials and then I will write about some very exciting future options.