Unmet Needs in Psychiatry: Bipolar Depression

摘要: Depressive phases of bipolar disorders (BD) present major challenges for treatment and comprehensive clinical management. They are the main component psychiatric morbidity in BD, even with treatment, associated excess mortality from co-occurring general-medical as well very high suicide risk. BD patients exceed general population risks a range medical disorders, notably including metabolic syndrome marked by obesity diabetes, cardiovascular congestive heart failure stroke. Some these may have selective relationship depression reflecting overall morbidity. Resulting rates several-times higher than some other disorders. Suicide risk is approximately 20-times above general-population rates, greater most strongly mixed (agitated-dysphoric) depressive BD. Specific, clinically effective prediction individual suicidal behavior its timing limited. Treatments that reduce risk, lithium perhaps clozapine or ketamine, not securely proved remain untested. Treatment far less investigated unipolar depression, value antidepressants short-term prophylactic disorder remains controversial they best avoided current agitated-mixed dysphoric states. For evidence efficacy mood-stabilizing agents, several anticonvulsants (except lamotrigine, long-term) limited; emerging use modern antipsychotics encouraging acute especially features. All available treatments used include adverse neurological effects.