Management of long-term depression: bipolar depression

Abstract

A great number of bipolar patients are underdiagnosed or undertreated, which worsens the course of their disease, comorbidity and the economic burden associated. Depressive episodes prevail in the bipolar patient’s life, both in subtypes I and II. These episodes are similar clinically to unipolar disorder depressive episodes, and, in addition, bipolar disorders usually start with a depressive episode in around 60% of cases. Although in most cases depressive symptomatology is usually mild or moderate, it frequently has cognitive dysfunction associated and is especially disabling for the patient. In addition, depressive episodes usually are more frequent, longer, and with a higher mortality due to suicidal behaviors. During euthimic periods, subclinical depressive symptoms often remain and interfere with the functioning and quality of life. The use of antidepressants for the treatment of bipolar depression is a controversial issue. Still, authors agree in the need to use always a mood stabilizer drug. The main relevant factors for an optimal treatment strategy are revised: clinical severity, disability, psychotic symptoms, rapid cycling, mixed or dysphoric symptoms, risk of suicide, presence of residual or subclinical depressive symptoms.