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A meta-analysis has found quetiapine monotherapy and combination olanzapine-fluoxetine to be the two most effective interventions for treating bipolar depression. The new findings indicate that atypical antipsychotics have greater efficacy than some currently recommended drugs for managing bipolar depression, and provide a rationale for reevaluating existing guidelines for treating this population.
Lead study author Eduard Vieta, M.D., Director of the Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, Barcelona, Spain, told The Update: "Our meta-analysis examined the effectiveness of treatments of bipolar depression based on clinical trial data. After carefully examining the evidence base for available treatment options for acute bipolar depression, we concluded that the highest scientific support was that of quetiapine monotherapy and a combination of olanzapine and fluoxetine. Our meta-analysis provided little support for other strategies such as antidepressant monotherapy, lamotrigine, aripiprazole, or lithium." Vieta is also Professor of Psychiatry at the University of Barcelona.
Some guidelines (1-3) recommend the use of mood stabilizers (e.g., lamotrigine, lithium, divalproex), either as monotherapy or in combination with selective serotonin reuptake inhibitors (SSRIs), as first-line treatments for bipolar depression. Other guidelines recommend atypical antipsychotics (e.g., quetiapine, olanzapine) for managing bipolar depression, either alone or in combination with …