Evidence-based treatment strategies for treatment-resistant bipolar depression: a systematic review
Article first published online: 27 NOV 2012
© 2012 John Wiley and Sons A/S
Volume 15, Issue 1, pages 61–69, February 2013
How to Cite
Sienaert, P., Lambrichts, L., Dols, A. and De Fruyt, J. (2013), Evidence-based treatment strategies for treatment-resistant bipolar depression: a systematic review. Bipolar Disorders, 15: 61–69. doi: 10.1111/bdi.12026
- Issue published online: 22 JAN 2013
- Article first published online: 27 NOV 2012
- Received 22 August 2011, revised and accepted for publication 27 August 2012
- bipolar disorder;
- electroconvulsive therapy;
- treatment resistance
Sienaert P, Lambrichts L, Dols A, De Fruyt J. Evidence-based treatment strategies for treatment-resistant bipolar depression: a systematic review. Bipolar Disord 2012: 00: 000–000. © 2012 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd.
Objectives: Treatment resistance in bipolar depression is a common clinical problem that constitutes a major challenge for the treating clinician as there is a paucity of treatment options. The objective of this paper was to review the evidence for treatment options in treatment-resistant bipolar depression, as found in randomized controlled trials and with special attention to the definition and assessment of treatment resistance.
Methods: A Medline search (from database inception to May 2012) was performed using the search terms treatment resistance or treatment refractory, and bipolar depression or bipolar disorder, supplemented with 43 separate searches using the various pharmacologic agents or technical interventions as search terms.
Results: Only seven studies met our inclusion criteria. These studies examined the effects of ketamine (n = 1), (ar)modafinil (n = 2), pramipexole (n = 1), lamotrigine (n = 1), inositol (n = 1), risperidone (n = 1), and electroconvulsive therapy (ECT) (n = 2).
Conclusions: The available level I evidence for treatment strategies in resistant bipolar depression is extremely scarce, and although the response rates reported are reassuring, most of the strategies remain experimental. There is an urgent need for further study in homogeneous patient samples using a clear concept of treatment resistance.