Abstract
The concept of the bipolar-spectrum and of mixed features being a bridge between major depressive disorders and bipolar disorders (BDs) has become increasingly important in mood-disorder diagnoses. Under these circumstances, antidepressants (ADs) and mood stabilizers (MSs) should be used with caution in the treatment of major depressive episodes (MDEs) and to obtain long-term stability in BDs. Before treating MDEs, screening tools, specific symptom evaluation and medical history should be used to distinguish between bipolarity and mixed features in patients for whom AD monotherapy may present a risk. In these patients, a combination of ADs plus MSs or atypical antipsychotics is recommended, rather than AD monotherapy. Studies evaluating MSs for bipolar depression suggest that lamotrigine is the most reliable treatment and lithium has modest effects; there is a lack of clear evidence regarding the efficacy of valproate and carbamazepine. Recently, significant progress has been made with respect to the pathophysiology of mood disorders and the application of potential biomarkers. There is an opportunity to study novel drug mechanisms through the rediscovery of fast-acting drugs such as ketamine. It is anticipated that future research developments will involve the discovery of potential targets for new drugs and their application to personalized treatments.
Highlights
Recent preliminary evidence suggests a potential trans-nosological effect of selected atypical antipsychotics (AAPs) beyond only psychotic disorders
AAP monotherapy is recommended for mildly severe bipolar depression, while AAPs combined with mood stabilizers (MSs) or antidepressants (ADs) are recommended for moderate to severe depression [4,7]
This review provides an overview of standard AD and MS treatments for both the acute phase of major depressive episodes (MDEs) and long-term stabilization of bipolar disorders (BDs)
Summary
Recent preliminary evidence suggests a potential trans-nosological effect of selected atypical antipsychotics (AAPs) beyond only psychotic disorders. Treatment with antipsychotics is an effective augmentation option for major depressive disorders (MDDs), bipolar mania and depression. For cases of non-psychotic depression with no response to the initial treatment strategy, some guidelines suggest augmentation of treatment with an AAP such as aripiprazole or quetiapine [1,2,3]. The preferred initial treatment strategy for mania, regardless of type, was MSs plus AAPs; recently, AAP monotherapy has been considered the most effective first-line treatment [4,5,6]. Despite the increasing use of AAPs, MSs continue to play an important role in the management of bipolar mania and depression. Most mood disorders are characterized by the onset of a major depressive episode (MDE), and AD monotherapy is typically the first-line treatment.
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