Antidepressants in bipolar depression: when less is more

TL;DRAbstract

A 54-year-old woman with bipolar disorder was referred for a consultation for refractory depression. She has a family history of bipolar disorder. The initial course of her illness is described as clearly episodic, with full recovery between minor depressive and hypomanic episodes that she had been experiencing since her teens. At the age of 26, she developed postpartum depression and was treated with a tricyclic antidepressant. Later, after a manic episode, she was diagnosed with bipolar disorder and treated with a combination of lithium (plasma levels 0.7–0.9 mmol/L) and various antidepressants (i.e., all available selective serotonin reuptake inhibitors, bupropion, doxepine, amitriptyline and venlafaxine). In addition, she had trials of carbamazepine, sodium divalproex, lamotrigine and several neuroleptics. Her course of illness gradually became more chronic. For the last 10 years, she has been mostly depressed with intermittent improvements. At the time of consultation, she was sev

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