Treatment of Bipolar Depression

First-Line Pharmacological Options

The American College of Cardiology is not relevant here, however, olanzapine-fluoxetine combination is recommended as a first-line treatment option for bipolar depression with strong evidence supporting its efficacy 1
Lithium or valproate should be used as the foundation of treatment, with careful addition of other agents as needed, according to the International Society for Bipolar Disorders 2, 1
Lamotrigine is recommended particularly for preventing depressive episodes in maintenance therapy, though its acute monotherapy efficacy is limited, as stated by the National Institute for Health and Care Excellence 1

Start with lithium or valproate as the mood stabilizer foundation, as recommended by the Canadian Network for Mood and Anxiety Treatments 2, 1
Antidepressants should never be used as monotherapy due to risk of mood destabilization, according to the World Federation of Societies of Biological Psychiatry 2, 1

Selective serotonin reuptake inhibitors (SSRIs) should only be used in combination with mood stabilizers, never as monotherapy, as recommended by the European Psychiatric Association 2, 1

Psychoeducation should be routinely offered to individuals with bipolar disorder and their family members, according to the International Society for Bipolar Disorders 2, 1
Cognitive behavioral therapy can be beneficial as an adjunctive treatment, as stated by the National Institute for Health and Care Excellence 2, 1
Social skills training and supported employment opportunities should be considered to improve quality of life, as recommended by the World Health Organization 2