- Although this comes as no surprise to me, there is now clear evidence that lithium is the most efficacious single agent for managing bipolar mania and bipolar depression. If, for whatever reason, lithium is not effective as monotherapy, combining Depakote with it does increase efficacy – although not markedly. The lithium/Depakote combination therefore is optimal in the treatment of bipolar mania.
- It is becoming increasingly more evident that traditional antidepressants (cyclics, SSRIs, SNRIs, Atypicals) have little, if any advantage, in the treatment of bipolar depression.
- All second-generation antipsychotics are approved for bipolar mania, and as a class, are generally helpful. Most however, are not effective in bipolar depression, with the exception of Seroquel and Abilify.
- The latest research demonstrates that Seroquel and Abilify are useful in unipolar and bipolar depression – whether used as monotherapy or as augmentation – but that Risperdal, Zyprexa and Geodon are not, in the same clinical circumstances.
From clinical experience, what are your impressions?