From the Research
The National Institute for Health and Care Excellence (NICE) guidelines for treating bipolar disorder during depressive episodes recommend a structured psychological intervention as first-line treatment for mild to moderate depression, with medication options including quetiapine, olanzapine combined with fluoxetine, or lamotrigine for more severe cases, as supported by the most recent study 1.
Key Recommendations
- For mild to moderate depression, a structured psychological intervention is recommended as first-line treatment.
- For more severe depression, medication options include:
- Quetiapine, with typical dosing starting at 50mg/day and gradually increasing to 300mg/day.
- Olanzapine combined with fluoxetine.
- Lamotrigine, which requires careful titration starting at 25mg/day and increasing over 6 weeks to 200mg/day to minimize rash risk.
- Lithium can be considered with an antidepressant if first-line options are ineffective, with dosing aimed at achieving serum levels of 0.6-0.8 mmol/L and regular monitoring.
Important Considerations
- Antidepressants should not be used alone due to the risk of triggering mania, as highlighted in 2.
- Psychological interventions typically involve 16-20 sessions of cognitive behavioral therapy or interpersonal therapy.
- Monitoring for signs of switching to mania is crucial, particularly when antidepressants are used, and successful treatment should be continued for at least 2 years to prevent relapse, as emphasized in 3.
Evidence Base
The recommendations are based on the most recent and highest quality study 1, which provides an overview of the diagnosis and treatment of bipolar disorder, including the importance of early diagnosis and treatment, and the role of mood stabilizers, antipsychotic agents, and antidepressants in management. Additional support is found in 4, which discusses the treatment of bipolar depression and the importance of individualizing treatment decisions based on potential adverse events.