Treatment-resistant bipolar depression: towards a new definition

• Published in: Acta psychiatrica Scandinavica Vol. 120; no. 6; pp. 429 - 440
• Main Authors: Pacchiarotti, I., Mazzarini, L., Colom, F., Sanchez-Moreno, J., Girardi, P., Kotzalidis, G. D., Vieta, E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.2009; Blackwell
• Subjects: Adult and adolescent clinical studies; Anticonvulsants - pharmacology; Anticonvulsants - therapeutic use; Antidepressive Agents - pharmacology; Antidepressive Agents - therapeutic use; Antipsychotic Agents - pharmacology; Antipsychotic Agents - therapeutic use; Benzodiazepines - pharmacology; Benzodiazepines - therapeutic use; Biological and medical sciences; bipolar depression; Bipolar disorder; Bipolar Disorder - diagnosis; Bipolar Disorder - drug therapy; Bipolar disorders; Clinical trials; Definitions; Depression; Dibenzothiazepines - pharmacology; Dibenzothiazepines - therapeutic use; Drug Resistance - drug effects; evidence-based guidelines; Evidence-Based Practice; Fluoxetine - pharmacology; Fluoxetine - therapeutic use; Humans; Lithium - pharmacology; Lithium - therapeutic use; Medical sciences; Mental depression; Mood disorders; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quetiapine Fumarate; Randomized Controlled Trials as Topic; treatment-resistant; Mood disorder; bipolar depression; Treatment resistance; Evidence-based practice; Definition; evidence-based guidelines; Depression; Bipolar disorder; treatment-resistant; Recommendation
• ISSN: 0001-690X; 1600-0447
• DOI: 10.1111/j.1600-0447.2009.01471.x

Objective:  To summarize the conceptual and operational definitions of treatment‐resistant bipolar depression and to review the evidence‐based therapeutic options. Method:  Structured searches of PubMed, Index Medicus, Excerpta Medica and Psyclit conducted in December 2008. Results:  Criteria for treatment resistance in bipolar depression are commonly based on concepts stemming from treatment resistance as defined for unipolar depression, an approach that proved to be inadequate. In fact, the addition of an ad hoc criterion based on lithium and other mood stabilizer unresponsiveness after reaching adequate plasma levels appears to be a patch that attempts to take into account the uniqueness of bipolar depression but fails to become operational. Recent data from randomized clinical trials of new anticonvulsants and second‐generation antipsychotics should lead to the development of a modern definition of treatment‐resistant bipolar depression, and specific therapeutic algorithms. Conclusion:  We suggest a redefinition of resistant bipolar I and II depression. We propose different degrees of severity within bipolar depression in a stepwise manner.