From the Research
The best treatment for bipolar II depression is olanzapine + fluoxetine, as it has been ranked highest for effect size and response, and has the optimal effect on response and withdrawal from treatment, according to a multiple-treatments meta-analysis 1. This treatment approach is supported by the most recent and highest quality study, which included 29 studies and 8331 participants. The study found that olanzapine + fluoxetine performed best on the primary outcome measure, and was also ranked the highest for response.
- Other treatment options, such as olanzapine, quetiapine, lurasidone, valproate, and selective serotonin re-uptake inhibitors, are also recommended, but with a lower ranking than olanzapine + fluoxetine.
- It is essential to note that some treatments, such as monoamine oxidase inhibitors, ziprasidone, aripiprazole, and risperidone, have limited or no therapeutic activity in bipolar depression, and should not be used.
- Additionally, tricyclic antidepressants and lithium are worthy of consideration, but lamotrigine should not be used due to its high risk of switching and less robust efficacy.
- Cognitive behavioral therapy (CBT) or interpersonal and social rhythm therapy (IPSRT) should accompany medication treatment, and regular sleep patterns, stress management, and avoiding alcohol and recreational drugs are important lifestyle components.
- Treatment should be continued even during symptom-free periods to prevent relapse, with medication adjustments made under medical supervision, as supported by earlier studies 2, 3, 4, 5.