Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-25T19:32:05.868Z Has data issue: false hasContentIssue false

Chapter 21 - The Burden of Bipolar Depression

Published online by Cambridge University Press:  16 May 2024

By
Allan Young  and
Dominic Cottrell
Edited by
Allan Young ,
Marsal Sanches ,
Jair C. Soares  and
Mario Juruena
Allan Young
Affiliation:
Institute of Psychiatry, King's College London
Marsal Sanches
Affiliation:
Baylor College of Medicine, Texas
Jair C. Soares
Affiliation:
McGovern Medical School, The University of Texas
Mario Juruena
Affiliation:
King's College London
Get access

Summary

Bipolar depression is an important and difficult to treat facet of bipolar disorder. However, it poses a number of challenges to the clinician. This chapter offers an overview of the difficulties in diagnosing bipolar depression and the main risks associated with it, whilst emphasising the factors which differentiate it from unipolar depression. Following this, there is an overview of the official guidance and evidence base for treatment options. There is an especial focus on pharmacotherapy, but the chapter also reviews psychotherapy, ECT, as well as emerging treatment options, such as sleep interventions and ketamine.

Keywords

bipolardepressionaffectivemoodpharmacotherapymedicationdiagnosis
Type
Chapter
Information
Clinical Textbook of Mood Disorders , pp. 213 - 221
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ferrari, AJ, Stockings, E, Khoo, JP, et al. The prevalence and burden of bipolar disorder: findings from the Global Burden of Disease Study 2013. Bipolar Disord 2016 Aug;18(5):440–50.CrossRefGoogle ScholarPubMed
Manning, JS. Burden of illness in bipolar depression. Prim Care Companion J Clin Psychiatry 2005;7(6):259–67.Google ScholarPubMed
Vojta, C, Kinosian, B, Glick, H, Altshuler, L, Bauer, MS. Self-reported quality of life across mood states in bipolar disorder. Compr Psychiatry 2001 May–Jun;42(3):190–5.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Schettler, PJ, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002 Jun;59(6):530–7.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Schettler, PJ, et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003 Mar;60(3):261–9.CrossRefGoogle ScholarPubMed
Mitchell, PB, Malhi, GS. Bipolar depression: phenomenological overview and clinical characteristics. Bipolar Disord 2004 Dec;6(6):530–9.CrossRefGoogle ScholarPubMed
Keller, MB, Lavori, PW, Coryell, W, et al. Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness. JAMA 1986 Jun 13;255(22):3138–42.CrossRefGoogle ScholarPubMed
Taylor, RH, Ulrichsen, A, Young, AH, Strawbridge, R. Affective lability as a prospective predictor of subsequent bipolar disorder diagnosis: a systematic review. Int J Bipolar Disord 2021 Nov 1;9(1):33–021–00237–1.CrossRefGoogle ScholarPubMed
Angst, J, Azorin, JM, Bowden, CL, et al. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study. Arch Gen Psychiatry 2011 Aug;68(8):791–7.CrossRefGoogle Scholar
Valentí, M, Pacchiarotti, I, Bonnín, CM, et al. Risk factors for antidepressant-related switch to mania. J Clin Psychiatry 2012 Feb;73(2):e271–6.CrossRefGoogle ScholarPubMed
Tondo, L, Pompili, M, Forte, A, Baldessarini, RJ. Suicide attempts in bipolar disorders: comprehensive review of 101 reports. Acta Psychiatr Scand 2016 Mar;133(3):174–86.CrossRefGoogle ScholarPubMed
Yatham, LN, Kennedy, SH, Parikh, SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018 Mar;20(2):97–170.CrossRefGoogle Scholar
Dilsaver, SC, Chen, YW, Swann, AC, et al. Suicidality, panic disorder and psychosis in bipolar depression, depressive-mania and pure-mania. Psychiatry Res 1997 Nov 14;73(1–2):47–56.CrossRefGoogle ScholarPubMed
Holma, KM, Haukka, J, Suominen, K, et al. Differences in incidence of suicide attempts between bipolar I and II disorders and major depressive disorder. Bipolar Disord 2014 Sep;16(6):652–61.CrossRefGoogle ScholarPubMed
Berlim, MT, Pargendler, J, Caldieraro, MA, et al. Quality of life in unipolar and bipolar depression: are there significant differences? J Nerv Ment Dis 2004 Nov;192(11):792–5.CrossRefGoogle ScholarPubMed
Baldessarini, RJ, Tondo, L, Baethge, CJ, Lepri, B, Bratti, IM. Effects of treatment latency on response to maintenance treatment in manic-depressive disorders. Bipolar Disord 2007 Jun;9(4):386–93.CrossRefGoogle ScholarPubMed
Fagiolini, A, Coluccia, A, Maina, G, et al. Diagnosis, epidemiology and management of mixed states in bipolar disorder. CNS Drugs 2015 Sep;29(9):725–40.CrossRefGoogle ScholarPubMed
Goodwin, GM, Haddad, PM, Ferrier, IN, et al. Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016 Jun;30(6):495–553.CrossRefGoogle ScholarPubMed
Malhi, GS, Bell, E, Boyce, P, et al. The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary. Bipolar Disord 2020 Dec;22(8):805–21.Google ScholarPubMed
Mauer, S, Alahmari, R, Vöhringer, PA, et al. International prescribing patterns for mood illness: the International Mood Network (IMN). J Affect Disord 2014;167:136–9.CrossRefGoogle ScholarPubMed
Baldessarini, RJ, Leahy, L, Arcona, S, et al. Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders. Psychiatr Serv 2007 Jan;58(1):85–91.CrossRefGoogle ScholarPubMed
Serafini, G, Vazquez, G, Monacelli, F, et al. The use of antidepressant medications for bipolar I and II disorders. Psychiatry Res 2021 Feb;296:113273.CrossRefGoogle ScholarPubMed
Viktorin, A, Lichtenstein, P, Thase, ME, et al. The risk of switch to mania in patients with bipolar disorder during treatment with an antidepressant alone and in combination with a mood stabilizer. Am J Psychiatry 2014 Oct;171(10):1067–73.CrossRefGoogle ScholarPubMed
Pacchiarotti, I, Bond, DJ, Baldessarini, RJ, et al. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry 2013 Nov;170(11):1249–62.CrossRefGoogle ScholarPubMed
Sachs, GS, Nierenberg, AA, Calabrese, JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med 2007 Apr 26;356(17):1711–22.CrossRefGoogle ScholarPubMed
Truman, CJ, Goldberg, JF, Ghaemi, SN, et al. Self-reported history of manic/hypomanic switch associated with antidepressant use: data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). J Clin Psychiatry 2007 Oct;68(10):1472–9.CrossRefGoogle ScholarPubMed
McGirr, A, Vöhringer, PA, Ghaemi, SN, Lam, RW, Yatham, LN. Safety and efficacy of adjunctive second-generation antidepressant therapy with a mood stabiliser or an atypical antipsychotic in acute bipolar depression: a systematic review and meta-analysis of randomised placebo-controlled trials. Lancet Psychiatry 2016 Dec;3(12):1138–46.CrossRefGoogle ScholarPubMed
Bahji, A, Ermacora, D, Stephenson, C, Hawken, ER, Vazquez, G. Comparative efficacy and tolerability of pharmacological treatments for the treatment of acute bipolar depression: a systematic review and network meta-analysis. J Affect Disord 2020 May 15;269:154–84.CrossRefGoogle ScholarPubMed
El-Mallakh, RS, Vöhringer, PA, Ostacher, MM, et al. Antidepressants worsen rapid-cycling course in bipolar depression: a STEP-BD randomized clinical trial. J Affect Disord 2015 Sep 15;184:318–21.CrossRefGoogle ScholarPubMed
Taylor, DM, Cornelius, V, Smith, L, Young, AH. Comparative efficacy and acceptability of drug treatments for bipolar depression: a multiple-treatments meta-analysis. Acta Psychiatr Scand 2014 Dec;130(6):452–69.CrossRefGoogle ScholarPubMed
Ostacher, M, Ng-Mak, D, Patel, P, et al. Lurasidone compared to other atypical antipsychotic monotherapies for bipolar depression: a systematic review and network meta-analysis. World J Biol Psychiatry 2018 Dec;19(8):586–601.CrossRefGoogle ScholarPubMed
Kadakia, A, Dembek, C, Heller, V, et al. Efficacy and tolerability of atypical antipsychotics for acute bipolar depression: a network meta-analysis. BMC Psychiatry 2021 May 11;21(1):249–021–03220–3.CrossRefGoogle ScholarPubMed
Earley, W, Burgess, MV, Rekeda, L, et al. Cariprazine treatment of bipolar depression: a randomized double-blind placebo-controlled phase 3 study. Am J Psychiatry 2019 Jun 1;176(6):439–48.CrossRefGoogle ScholarPubMed
Earley, WR, Burgess, MV, Khan, B, et al. Efficacy and safety of cariprazine in bipolar I depression: a double-blind, placebo-controlled phase 3 study. Bipolar Disord 2020 Jun;22(4):372–84.CrossRefGoogle ScholarPubMed
Kishi, T, Yoshimura, R, Sakuma, K, Okuya, M, Iwata, N. Lurasidone, olanzapine, and quetiapine extended-release for bipolar depression: a systematic review and network meta-analysis of phase 3 trials in Japan. Neuropsychopharmacol Rep 2020 Dec;40(4):417–22.Google ScholarPubMed
Weiner, M, Warren, L, Fiedorowicz, JG. Cardiovascular morbidity and mortality in bipolar disorder. Ann Clin Psychiatry 2011 Feb;23(1):40–4.Google ScholarPubMed
Penninx, BWJH, Lange, SMM. Metabolic syndrome in psychiatric patients: overview, mechanisms, and implications. Dialogues Clin Neurosci 2018 Mar;20(1):63–73.CrossRefGoogle ScholarPubMed
Citrome, L, Ketter, TA, Cucchiaro, J, Loebel, A. Clinical assessment of lurasidone benefit and risk in the treatment of bipolar I depression using number needed to treat, number needed to harm, and likelihood to be helped or harmed. J Affect Disord 2014 Feb;155:20–7.CrossRefGoogle ScholarPubMed
Goodwin, GM, Malhi, GS. What is a mood stabilizer? Psychol Med 2007 May;37(5):609–14.CrossRefGoogle ScholarPubMed
Fountoulakis, KN, Tohen, M, Zarate, CA Jr. Lithium treatment of bipolar disorder in adults: a systematic review of randomized trials and meta-analyses. Eur Neuropsychopharmacol 2022 Jan;54:100–15.CrossRefGoogle ScholarPubMed
Young, AH, McElroy, SL, Bauer, M, et al. A double-blind, placebo-controlled study of quetiapine and lithium monotherapy in adults in the acute phase of bipolar depression (EMBOLDEN I). J Clin Psychiatry 2010 Feb;71(2):150–62.CrossRefGoogle ScholarPubMed
Bowden, CL, Calabrese, JR, Sachs, G, et al. A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry 2003 Apr;60(4):392–400.CrossRefGoogle ScholarPubMed
Bahji, A, Ermacora, D, Stephenson, C, Hawken, ER, Vazquez, G. Comparative efficacy and tolerability of adjunctive pharmacotherapies for acute bipolar depression: a systematic review and network meta-analysis. Can J Psychiatry 2021 Mar;66(3):274–88.CrossRefGoogle ScholarPubMed
Goodwin, GM. Recurrence of mania after lithium withdrawal. Implications for the use of lithium in the treatment of bipolar affective disorder. Br J Psychiatry 1994 Feb;164(2):149–52.CrossRefGoogle ScholarPubMed
Nolen, WA, Licht, RW, Young, AH, et al. What is the optimal serum level for lithium in the maintenance treatment of bipolar disorder? A systematic review and recommendations from the ISBD/IGSLI Task Force on treatment with lithium. Bipolar Disord 2019 Aug;21(5):394–409.CrossRefGoogle ScholarPubMed
Bond, DJ, Lam, RW, Yatham, LN. Divalproex sodium versus placebo in the treatment of acute bipolar depression: a systematic review and meta-analysis. J Affect Disord 2010 Aug;124(3):228–34.CrossRefGoogle ScholarPubMed
Smith, LA, Cornelius, VR, Azorin, JM, et al. Valproate for the treatment of acute bipolar depression: systematic review and meta-analysis. J Affect Disord 2010 Apr;122(1–2):1–9.CrossRefGoogle ScholarPubMed
Jochim, J, Rifkin-Zybutz, RP, Geddes, J, Cipriani, A. Valproate for acute mania. Cochrane Database Syst Rev 2019 Oct 7;10(10):CD004052.Google ScholarPubMed
Hashimoto, Y, Kotake, K, Watanabe, N, Fujiwara, T, Sakamoto, S. Lamotrigine in the maintenance treatment of bipolar disorder. Cochrane Database Syst Rev 2021 Sep 15;9(9):CD013575.Google ScholarPubMed
Besag, FMC, Vasey, MJ, Sharma, AN, Lam, ICH. Efficacy and safety of lamotrigine in the treatment of bipolar disorder across the lifespan: a systematic review. Ther Adv Psychopharmacol 2021 Oct 8;11:20451253211045870.CrossRefGoogle ScholarPubMed
Yalin, N, Young, AH. Pharmacological treatment of bipolar depression: what are the current and emerging options? Neuropsychiatr Dis Treat 2020 Jun 9;16:1459–72.CrossRefGoogle ScholarPubMed
Cipriani, A, Barbui, C, Salanti, G, et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. Lancet 2011 Oct 8;378(9799):1306–15.CrossRefGoogle Scholar
Edinoff, AN, Nguyen, LH, Fitz-Gerald, MJ, et al. Lamotrigine and Stevens-Johnson syndrome prevention. Psychopharmacol Bull 2021 Mar 16;51(2):96–114.Google ScholarPubMed
Chiang, KJ, Tsai, JC, Liu, D, et al. Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: a meta-analysis of randomized controlled trials. PLoS One 2017 May 4;12(5):e0176849.CrossRefGoogle ScholarPubMed
Miklowitz, DJ, Efthimiou, O, Furukawa, TA, et al. Adjunctive psychotherapy for bipolar disorder: a systematic review and component network meta-analysis. JAMA Psychiatry 2021 Feb 1;78(2):141–50.CrossRefGoogle ScholarPubMed
UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003 Mar 8;361(9360):799–808.CrossRefGoogle Scholar
Perugi, G, Medda, P, Toni, C, et al. Role of electroconvulsive therapy (ECT) in bipolar disorder: effectiveness in 522 patients with bipolar depression, mixed-state, mania and catatonic features. Curr Neuropharmacol 2017 Apr;15(3):359–71.CrossRefGoogle ScholarPubMed
Liang, CS, Chung, CH, Ho, PS, Tsai, CK, Chien, WC. Superior anti-suicidal effects of electroconvulsive therapy in unipolar disorder and bipolar depression. Bipolar Disord 2018 Sep;20(6):539–46.CrossRefGoogle ScholarPubMed
Loo, C, Katalinic, N, Mitchell, PB, Greenberg, B. Physical treatments for bipolar disorder: a review of electroconvulsive therapy, stereotactic surgery and other brain stimulation techniques. J Affect Disord 2011 Jul;132(1–2):1–13.CrossRefGoogle ScholarPubMed
Dierckx, B, Heijnen, WT, van den Broek, WW, Birkenhäger, TK. Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis. Bipolar Disord 2012 Mar;14(2):146–50.CrossRefGoogle ScholarPubMed
Bahji, A, Hawken, ER, Sepehry, AA, Cabrera, CA, Vazquez, G. ECT beyond unipolar major depression: systematic review and meta-analysis of electroconvulsive therapy in bipolar depression. Acta Psychiatr Scand 2019 Mar;139(3):214–26.CrossRefGoogle ScholarPubMed
Bjoerke-Bertheussen, J, Schoeyen, H, Andreassen, OA, et al. Right unilateral electroconvulsive therapy does not cause more cognitive impairment than pharmacologic treatment in treatment-resistant bipolar depression: a 6-month randomized controlled trial follow-up study. Bipolar Disord 2018 Sep;20(6):531–8.CrossRefGoogle Scholar
McIntyre, RS, Carvalho, IP, Lui, LMW, et al. The effect of intravenous, intranasal, and oral ketamine in mood disorders: a meta-analysis. J Affect Disord 2020 Nov 1;276:576–84.CrossRefGoogle ScholarPubMed
McIntyre, RS, Rosenblat, JD, Nemeroff, CB, et al. Synthesizing the evidence for ketamine and esketamine in treatment-resistant depression: an international expert opinion on the available evidence and implementation. Am J Psychiatry 2021 May 1;178(5):383–99.CrossRefGoogle ScholarPubMed
Bahji, A, Zarate, CA, Vazquez, GH. Ketamine for bipolar depression: a systematic review. Int J Neuropsychopharmacol 2021 Jul 23;24(7):535–41.CrossRefGoogle ScholarPubMed
Dean, RL, Marquardt, T, Hurducas, C, et al. Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder. Cochrane Database Syst Rev 2021 Oct 8;10(10):CD011611.Google ScholarPubMed
Ng, TH, Chung, KF, Ho, FY, et al. Sleep-wake disturbance in interepisode bipolar disorder and high-risk individuals: a systematic review and meta-analysis. Sleep Med Rev 2015 Apr;20:46–58.CrossRefGoogle ScholarPubMed
Melo, MCA, Abreu, RLC, Linhares Neto, VB, de Bruin, PFC, de Bruin, VMS. Chronotype and circadian rhythm in bipolar disorder: a systematic review. Sleep Med Rev 2017 Aug;34:46–58.CrossRefGoogle ScholarPubMed
Cretu, JB, Culver, JL, Goffin, KC, Shah, S, Ketter, TA. Sleep, residual mood symptoms, and time to relapse in recovered patients with bipolar disorder. J Affect Disord 2016 Jan 15;190:162–6.CrossRefGoogle ScholarPubMed
Takaesu, Y. Circadian rhythm in bipolar disorder: a review of the literature. Psychiatry Clin Neurosci 2018 Sep;72(9):673–82.CrossRefGoogle ScholarPubMed
Gold, AK, Kinrys, G. Treating circadian rhythm disruption in bipolar disorder. Curr Psychiatry Rep 2019 Mar 2;21(3):14–019–1001–8.CrossRefGoogle ScholarPubMed
Maruani, J, Geoffroy, PA. Bright light as a personalized precision treatment of mood disorders. Front Psychiatry 2019 Mar 1;10:85.CrossRefGoogle ScholarPubMed
Tuunainen, A, Kripke, DF, Endo, T. Light therapy for non-seasonal depression. Cochrane Database Syst Rev 2004;2004(2):CD004050.Google ScholarPubMed
Hirakawa, H, Terao, T, Muronaga, M, Ishii, N. Adjunctive bright light therapy for treating bipolar depression: a systematic review and meta-analysis of randomized controlled trials. Brain Behav 2020 Dec;10(12):e01876.CrossRefGoogle ScholarPubMed
Dallaspezia, S, Benedetti, F. Antidepressant light therapy for bipolar patients: a meta-analyses. J Affect Disord 2020 Sep 1;274:943–8.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×