Managing Bipolar Depression – You Should Know What Doctors Know

April 18, 2013 Natasha Tracy

Today I tuned into a webcast on managing bipolar depression. I wasn’t sure what to expect although I was aware the webcast was designed for doctors so I knew the level of discourse would be high.

And I must say it was a great hour. Granted, I knew the vast majority of what was being presented but the nuggets of new items here and there definitely made it worthwhile.

What’s more is that this view on managing bipolar depression is evidence-based and they present the numbers behind what’s recommended. They make clear which studies are drug company-funded and which are not. It’s the kind of information that I wish every doctor knew.

And, if you have bipolar, especially bipolar depression, it’s the kind of information you should know too.

Doctor-Developed Information

Yes, I know, the downside of this type of information is the same as the upside – it was designed by and for doctors. This is the good and the bad news. The good news is that it’s highly current and scientifically accurate; the bad news is it’s hard to assimilate for many people. It’s one of the reasons I’m around. I watch the webcasts so I can write articles that talk about the information therein.

Of course, I would always recommend that you view the information first-hand, if possible. Like I said, it’s not the easiest to understand, for many people, but if you can really focus and take notes, I think you’ll learn something. (This webcast is only an hour so it’s not so bad.)

Managing Bipolar Depression – Diagnosis of Bipolar

So, to the nuggets. I learned a couple of new things and had a few older things reinforced.

Here’s an interesting tidbit: 50% of people who are bipolar present in a depression with no known elevated mood episodes. So, in other words, while we know there is a high rate of misdiagnosis (69% for bipolar), it’s not all the doctor’s fault. Many people are misdiagnosed even though the doctor does everything right.

Here are the depressive presentations that increase the risk of a bipolar outcome:

  • Acute onset or abrupt offset of depression
  • Early onset of first depression (under the age of 25)
  • Family history of bipolar
  • Presence of postpartum depression
  • Seasonal affective disorder (SAD)
  • Antidepressant-induced hypomania or mania
  • Recurrent major depressive disorder
  • Atypical depressive symptoms (oversleeping and overeating come to mind but this topic needs its whole own article)

Managing Bipolar Depression – What Works

As many people know, only two treatments are currently FDA-approved to treat bipolar depression: quetiapine and an olanzapine/fluoxetine combination. But the good news from the presentation is:

  • Psychotherapy works as well as some pharmacology (specifically cognitive behavioral therapy and to a lesser extent, anything involving psychoeducation)
  • Intense psychotherapy (12 or more sessions) is more effective than brief psychoeducation
  • Lurasidone looks extremely promising for bipolar depression (astonishing numbers currently under review by the FDA for approval, drug currently approved for schizophrenia treatment. Main side effect sedation and no weight gain according to study.)
  • Lithium significantly reduces the risk of suicide
  • Armodafinil is worth looking at for adjunctive use in bipolar depression

Yes, I could write an article on each bullet point, but I wanted to hit the highlights.

If you want to see the webcast, and I highly advise that you do (and then download the slide deck), you can sign up here (it's free).

(It goes without saying that any and all changes should be reviewed with your healthcare provider and the information presented here is by me, a non-doctor.)

One other thing, here is a list of names you’ll need to know if you want to watch the webcast:

  • Aripiprazole – Abilify
  • Bupropion - Welbutrin
  • Fluoxetine – Prozac
  • Lamotrigine – Lamictal
  • Lurasidone – Latuda
  • Olanazpine - Zyprexa
  • Paroxetine – Paxil
  • Quetiapine – Seroquel
  • Sertraline – Zoloft
  • Valproate – Depakote (Epival)
  • Venlafaxine – Effexor
  • Ziprasidone – Geodon

You can find Natasha Tracy on Facebook or GooglePlus or @Natasha_Tracy on Twitter.

APA Reference
Tracy, N. (2013, April 18). Managing Bipolar Depression – You Should Know What Doctors Know, HealthyPlace. Retrieved on 2024, July 17 from

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate, and author of Lost Marbles: Insights into My Life with Depression & Bipolar. She's also the host of the podcast Snap Out of It! The Mental Illness in the Workplace Podcast.

Find Natasha Tracy on her blog, Bipolar BurbleTwitter, InstagramFacebook, and YouTube.

David Blistein
April, 19 2013 at 9:10 am

During one particularly virulent episode, I asked my doctor: "If I'm bipolar why aren't I get the creative mania periods." He said, "Well, there's dysphoria as well as euphoria." Which to me, while not a pretty picture, explained a lot.

Ernie Richards
April, 19 2013 at 10:49 am

Thanks for the great information Natasha. I have wanted to view the webinar but on the low speed connection I am using I was afraid of not being able to view it.
Several of your bullet points in the depressive presentations that increase the risk of a bipolar outcome section hit home for me.

April, 19 2013 at 11:10 am

I seriously doubt this Latuda is going to pan out for bipolar depression. I've had bipolar a very long time, and these promising new treatments never pan out in the long run, and often have a very dark side to them.

Deborah Ferry
April, 19 2013 at 10:50 pm

Even though I have bipolar disorder (along with OCD and PTSD), I'm currently going without treatment as I could find no psychiatrists in the Phoenix area that take Medicare. (Please don't ask me to contact Medicare as their listing is decades out of date.) Even the public mental health system, such as it is, is not a Medicare provider. (They primarly only help people on Medicaid, which I don't qualify for.) Unfortunately, I can't afford, the private pay rates that start at around $175 per session so I just do without. Is the lack of Medicare psychiatric providers a widespread problem and can anything be done about it?

April, 20 2013 at 6:31 pm

Our medicare covers all in patient and out patient treatment and pharmaceuticals benefits (you pay $5 on a pension card and up to $35 without). It also pays a benfefit toward GP, psychologist etc, which is at least 50% of what they actually charge. Nobody is ever without treatment, unless they choose not to comply, which is a different story. In this country we recognise that not everybody is responsible for their circumstances (to a degree).

Charles Mistretta
April, 21 2013 at 2:39 am

Again, know thyself. If crowds, loud noises and certain people are a potential threat, avoid them. Yesterday I ignored all of the above, while knowing better, and got sick. Medication can help but often throws a wet blanket on the fire - no flames, but plenty of smoke, just as bad. Finding the right doctor with enough knowledge is possible. I learned that I was unipolar (depressive). The change to Prozac offered some relief. Effexor pushed me to high, and Seroquel evaporated any hope of reality that was fun. These are personal responses only and may not remotely effect anyone else. My struggle to find peace of mind has taken many decades. I still have surprise episodes, some are scary... What I am saying is that managing depression can take a long time. Managing Bipolar Depression articles like this one can help, but you have to do something. Please do.

June, 13 2013 at 9:01 pm

Where did you hear the broadcast of this and on what date was it. i am having trouble finding this.can you email this info, Thanks

June, 29 2013 at 9:33 am

to ms. deborah ferry there is a place called value options on Peoria ave. and I think 35th or so its right by the mall if you apply through them you may recieve discounted or free help with your bipolar ocd and ptsd medications most of them anyway can be gotten at frys pharmacy for 4 dollars there is no reason to not get the help you need

June, 29 2013 at 11:20 am

Look up Arizona Neurological Institute. They are a practice of many different kinds of doctors, one of them being a psychiatrist and there's also his PA that sees patients as well.
According to their website, the practice accepts Medicare.
Good luck and I hope you find these comments!

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