Acute Treatment of Depressive Episode
Treating the depressive episode in bipolar disorder is controversial for two main reasons.
- First, antidepressant medication may send a person into a manic or hypomanic episode.
- Second, antidepressants may cause rapid cycling. A person may recover more quickly from depression, but may experience the next episode sooner.
To reduce these risks, most psychiatrists prescribe mood stabilizers (e.g., lithium, valproate) in combination with antidepressants. Once the symptoms of the depressive episode resolve, the dosage of the antidepressant medication is tapered down over several weeks and finally discontinued.
If psychotic symptoms are present during an acute depressive episode, antipsychotic medication is prescribed. This medication is not used for maintenance therapy because of serious side effects that develop over the long term.
Otherwise, treating an episode of depression in bipolar disorder is the same as major depressive disorder (see treatment of depression).