[Treatment of a first depressive episode in bipolar disorder]

The first episode of bipolar depression needs a combined psychopharmacological, psychobehavioural and social treatment strategy but because of the pathological severity of the mood episode itself, it specifically requires to achieve total symptomatic remission and therefore appropriate treatment of the index episode. International recommendations which derive primarily from Anglo-Saxon regulations formally restrict the use of antidepressants in view of the risk of mania, suggesting that serotoninergic agents be used in preference and recommending the prescription of mood regulators or even antipsychotic agents and various stepwise associations based on the relative potencies of the pharmacological tools available and treatment stages deployed optimally to obtain complete remission. Finally, treatment of the episode includes prophylaxis as its initial episode is the first presentation of a chronic disease.