Clinical inquiries: what drugs are best for bipolar depression?

Antidepressants and lamotrigine are effective. Atypical antipsychotics, lithium, and anticonvulsants also may help. Antidepressants, including tricyclics and selective serotonin reuptake inhibitors (SSRIs), are useful adjuncts in short-term treatment of bipolar depression and have low rates of inducing mania (strength of recommendation [SOR]: 1 systematic review and randomized controlled trials [RCTs]). Lamotrigine is beneficial for both acute treatment of bipolar depression and prevention of recurrent episodes (SOR: 1 systematic review and 1 RCT). Some atypical antipsychotics alone (SOR: 2 RCTs) or in combination with antidepressants (SOR: 1 multicenter RCT) effectively treat acute bipolar depression. Lithium and anticonvulsants such as valproate also may be useful (SOR: limited number of studies with small sample sizes).