Recent advances in bipolar disorder pharmacotherapy: focus on bipolar depression and rapid cycling

This article reviews recent advances in the evidence base for effective pharmacotherapy in bipolar disorder. We focus first on bipolar depression, since this pole of the illness forms the bulk of the burden of illness for both bipolar I and bipolar II patients. Recent studies throw doubt on the benefits of antidepressants in bipolar depression and suggest that selected mood stabilizers or second-generation antipsychotics may be effective alternatives. A second focus is on rapid-cycling bipolar disorder, a more severe phase of the illness, in which four or more episodes occur in a year. Although this form of the illness responds poorly to monotherapy, evidence is accumulating concerning which treatments are best combined in order to manage rapid cycling most effectively. Additional nonpharmacological management strategies are a vital element of the effective management of bipolar disorder but are beyond the scope of this review. Finally, suggestions are made for future research.