• benefits;
  • bipolar depression;
  • costs;
  • efficacy;
  • mood stabilizers

Objective:  The aim of this paper was to review the rationales, risks, and benefits for using standard antidepressants versus mood stabilizing agents and/or atypical antipsychotics to treat bipolar depression.

Method:  A selective literature review was conducted using key terms and by reference known to the authors. Bibliographies of articles and book chapters were further scrutinized for relevant literature.

Results:  The strengths and limitations of current studies are described and critically reviewed in order to present optimal strategies for effective pharmacotherapy. Clinical factors that can mitigate or confound simple bivariate relationships between antidepressant use and outcome have seldom been examined using multivariate statistical techniques. For many of the key questions there is a paucity of informative literature and randomized clinical trials are of limited value in addressing some of the issues.

Conclusions:  Clinicians and investigators should be aware of the methodological shortcomings of existing studies. Decisions about the relative merits versus contraindications for antidepressant use should be made via more individualized, case-by-case profiling rather than by rigid prescribing practices.