Treatment-resistant bipolar depression

Psychiatr Clin North Am. 1996 Jun;19(2):215-36. doi: 10.1016/s0193-953x(05)70285-9.


Patients with treatment-resistant bipolar depression require careful management, which takes into account the life-threatening potential of their depression and the risk of iatrogenic mania. Because there are few data specific to treatment of bipolar depression, much of the approach to bipolar depression is derived from experience with unipolar depression. There are, however, important differences between these two illnesses. Compared with patients with unipolar illness, patients with bipolar depression more likely experience antidepressant benefit from mood-stabilizing medication and, therefore, avoid the risks of antidepressant medication. Treatment of comorbid anxiety and substance abuse improves response. The risk of treating bipolar patients can be reduced but not avoided. Improved outcome may be achieved by careful assessment, prospective mood charting, and attempts to taper antidepressant medications after an appropriate continuation phase.

Publication types

  • Review

MeSH terms

  • Antidepressive Agents / administration & dosage
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use*
  • Antimanic Agents / therapeutic use
  • Bipolar Disorder / chemically induced
  • Bipolar Disorder / drug therapy*
  • Bipolar Disorder / prevention & control
  • Bipolar Disorder / therapy
  • Case Management
  • Clinical Protocols
  • Depressive Disorder / drug therapy
  • Drug Resistance
  • Drug Therapy, Combination
  • Electroconvulsive Therapy
  • Humans
  • Iatrogenic Disease / prevention & control
  • Lithium / therapeutic use
  • Patient Compliance
  • Recurrence


  • Antidepressive Agents
  • Antimanic Agents
  • Lithium