Treating Depression in Bipolar II Disorder

The following treatment guidelines are meant as a reference tool, but are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

Treatment for Depression in Bipolar II Disorder follows the same general principles as for Depression in Bipolar I Disorder, which are described here. However, the following special considerations apply:

• Quetiapine is the first-choice treatment option. It is recommended above the other options listed in Step 2.
• Using an antidepressant alone, without a mood stabilizer or atypical antipsychotic, can be tried in Step 2, but this option is considered third-line, with less supporting evidence than for the other options listed in Step.
  • SSRIs or Bupropion would be the antidepressants of choice.
  • This option should only be considered for individuals whose hypomanic episodes are infrequent.
  • Important controversies have been raised over the use of antidepressants in Bipolar Depression.

• In Step 4, N-acetylcysteine (NAC) and Triiodothyronine (T3) can be included as options to add. On the other hand, Pramipexole, Riluzole, Topiramate and Carbamazepine all lack any clear evidence that they are effective for Depression in Bipolar II Disorder.
• In Step 5, when it comes to maintenance treatment, any antidepressants that were tried and found helpful should be continued for at least 12 months. This is the case regardless of whether the antidepressant was used alone or in combination with other medications.

The above treatments strategies are based on the CANMAT Guidelines for the Management of Patients with Bipolar Disorder [ref, ref, ref, ref].