Citation

Camilleri V, Mauri M. Ital. J. Psychopathol. 2005; 11(4): 483-493.

Copyright

(Copyright © 2005, Pacini editore)

DOI

unavailable

PMID

unavailable

Abstract

OBJECTIVE: Depressive episodes in bipolar I and II disorders are an important source of morbidity and mortality. The objective of this review is to critically evaluate literature findings on the treatment of depressive episodes in patients with bipolar I and II disorders with atypical antipsychotics.

METHODS: Here we report a critical review of studies providing evidence for the treatment of bipolar I or II depressive episodes with atypical antipsychotic. Atypical antipsychotics are currently used for the acute treatment of manic episodes, and also for the prophylaxis of relapses and recurrences. More recently, some evidence seems to support the theory that atypical antipsychotics could be used also for the treatment of depressive episodes, in patients with bipolar disorder. This critical review is mainly focused on treatment with Quetiapine.

RESULTS: Bipolar depression differs from unipolar depression in several features, including earlier age at onset, a more even sex distribution, higher frequency in episodes, increased likelihood of psychotic symptoms, and a greater risk of suicide. Although multiple agents including several atypical antipsychotics, have demonstrated efficacy in the treatment of the manic phase of bipolar I disorder the acute treatment of bipolar depression has not been studied as thoroughly. Preliminary evidence for the efficacy of Quetiapine in the treatment of depressive symptoms in a variety of psychotic and mood disorders has been reported in several randomized or open-label studies. Based on the need for new treatment options for bipolar depression, the effectiveness of atypical antipsychotics in acute mania and the emerging evidence for their use in bipolar depression, Calabrese et al. (2005) performed a large, multicentre, randomized, double-blind, placebo-controlled trial of Quetiapine in the treatment of bipolar I or II depression. Five-hundred and forty-two outpatients with bipolar I (N = 360) or II (N = 182) disorder experiencing a major depressive episode (DSM-IV) were randomly assigned to 8 weeks of Quetiapine (600 or 300 mg/day) or placebo.

CONCLUSIONS: Currently, Olanzapine is the most studied atypical agent in bipolar disorder, and it has proved to be efficacious in the prevention of manic and depressive episodes for up to 1 year after a manic episode. Olanzapine-fluoxetine combination therapy is also efficacious in the treatment of acute bipolar I depression. Quetiapine is efficacious in the treatment of acute bipolar mania, both as monotherapy and in combination with other mood stabilizers.

Language: it

Keywords

adult; human; suicide; female; male; aged; psychosis; randomized controlled trial; major depression; clinical trial; bipolar depression; clozapine; mood disorder; article; major clinical study; controlled study; sex ratio; fluoxetine; sedation; controlled clinical trial; double blind procedure; headache; quetiapine; somnolence; recurrent disease; haloperidol; placebo; drug efficacy; olanzapine; risperidone; nausea; multicenter study; lorazepam; onset age; valproic acid; respiratory tract disease; mania; zolpidem; bipolar I disorder; bipolar II disorder; lamotrigine; side effect; atypical antipsychotic agent; ziprasidone; Quetiapine; dizziness