THE EXPERT CONSENSUS GUIDELINES FOR TREATING DEPRESSION IN BIPOLAR DISORDER

We present expert consensus guideline recommendations for the treatmen t of bipolar depression. These were arrived at through the statistical aggregation of the survey responses of 61 leading clinical researcher s to eight questions about the key decision points in the management o f bipolar depression. The experts' first-line recommendation for treat ing psychotic depression in bipolar disorder is to provide a combinati on of mood stabilizer, antidepressant, and neuroleptic medication. For severe, but nonpsychotic bipolar depression, the experts recommend th e combination of a mood stabilizer and an antidepressant. For milder b ipolar depression, a mood stabilizer and an antidepressant together or a mood stabilizer alone would be first line. The experts' antidepress ant dose and dosing schedule recommendations are equivalent for unipol ar and bipolar depression, but the experts recommend a faster disconti nuation of antidepressants during the maintenance phase in bipolar pat ients-probably to reduce the risk of rapid cycling. Among the antidepr essants, the experts prefer bupropion and the serotonin reuptake inhib itors as first line. They also believe that bupropion is least likely among antidepressants to cause switches to mania. Among mood stabilize rs, the experts rate lithium as most likely to have a direct antidepre ssant effect.