Pharmacotherapy of inpatients with bipolar depression

The pharmacotherapy of bipolar depression has not been well studied. Controlled studies support the efficacy of some antimanic and antidepressant drugs, but these studies usually exclude patients typically seen in nonresearch settings. The purpose of this study was to examine the pharmacotherapy of 69 inpatients with bipolar depression. More than 90% of the patients received at least one antimanic drug, and lithium was used most frequently. Only one-half of the patients received antidepressants. Three-quarters of antidepressant-treated patients received serotonin reuptake inhibitors or other nontricyclic drugs. There were few differences between antidepressant- and non-antidepressant-treated patients. Psychotic patients were more likely to receive lithium, neuroleptics, and anticholinergics, whereas nonpsychotic patients tended to receive anticonvulsants more often. Psychotic patients were also more likely to receive polypharmacy. These results suggest that polypharmacy of inpatients with bipolar depression is common, and that psychosis is an important variable in the choice of pharmacotherapy.