Regarding first-line clinical depression treatment for the management of bipolar
depression, the sheer number of research demonstrating lithium to be effective,
despite the fact that some of them are poorly designed, makes lithium the
best-established treatment. The group cited numerous research demonstrating
this. Particularly in studies noting the prophylactic qualities of lithium
against antidepressants, lithium was consistently as good or better than
antidepressants in preventing depressive symptomatology and considerably better
at preventing manic symptomatology. It is important to note also that these
research showed that placebo was considerably better than antidepressants in
preventing manic symptomatology.
The group then discussed the research examining the use of lamotrigine for
bipolar depression, and also found it convincing. In a nice comparison between
lithium and lamotrigine, lamotrigine seemed to be more effective at delaying
depressive episodes, and lithium seemed to be more effective at delaying manic
episodes. Most recently, evidence has shown that a combination of olanzapine and
fluoxetine had substantially higher rates of response and remission than either
olanzapine alone or placebo, although the olanzapine group was significantly
better than the placebo group.
The group then discussed the issues involved with clinical depression treatment
non-response. For non-rapid cycling patients, after optimization of the current
treatment proves ineffective, they recommended combining 2 first-line
treatments, although they admit there is very small, if any, evidence to support
this recommendation. The other option would be to add an antidepressant to the
first-line treatments, but they recommended strongly against tricyclics or
monoamine oxidase inhibitors, as there is evidence that these depression remedy
are the most likely to induce mania.
They also noted that there are more recent data that show that patients who
respond to clinical depression treatment added to a mood stabilizer are
considerably more likely to relapse if the antidepressant is stopped, and they
recommended that antidepressant treatment be continued with the mood stabilizer
for at least a year after remission of the said depression.
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