What drugs are best for bipolar depression?

Bipolar depression is a severe, potentially lethal disorder for which there are no specific, FDA-indicated pharmacotherapies. Research in this area has been limited, and most treatments are based on unsupported extrapolation from the treatment of unipolar depression, or follow guidelines derived largely from the clinical practice experience of experts in this field. There is clearly a medical need for new and more effective treatments for bipolar depression. Recently, the newer antiepileptic drugs, and atypical antipsychotics, have been studied to evaluate their role in bridging this gap in the psychopharmacologic armamentarium. Drugs in these classes will be reviewed, in addition to serotonin reuptake inhibitors, monoamine oxidase inhibitors, and electroconvulsive therapy. In this paper, current trends in the acute and long-term medication treatment of bipolar depression will be described, with particular focus on evidence from the existing literature. Additional factors, such as side effects, risk/benefit issues, and drug-drug interactions, will be considered in an attempt to make overall recommendations for medication selection.