Current guidelines for the management of bipolar depression are outdated because they are based on the definition and treatment of unipolar depression, according to Eduard Vieta, MD, PhD, director of the bipolar disorders program at the University Clinic Hospital of Barcelona, Spain. Vieta led a study to create new definitions and algorithms for the management of treatment-resistant bipolar I and bipolar II depression (Figures 1 and 2).1 He created the algorithms after encountering many patients within his practice who had bipolar disorder, were depressed, and did not respond to standard treatments. “For these patients, the current definitions of treatment-resistant depression are completely useless,” he said.
After conducting a literature review of hundreds of relevant articles, Vieta’s team found that although there have been many studies that focused on standardizing management of treatment-resistant unipolar depression, there have been very few attempts to standardize the approach to treatment-resistant bipolar depression. “Our study clearly pointed out that the treatment algorithms need to change dramatically,” he said. “Patients deserve to receive treatments that are evidence-based and specific to their condition.”