Because there are relatively few medications indicated for acute bipolar depression, many pharmacotherapies are used off-label.1,2 Beyond pharmacotherapy, there is some evidence in favour of interventions such as electroconvulsive therapy and transcranial magnetic stimulation, and various forms of psychotherapy, in patients with bipolar disorder and acute depression; however, more research is needed to fully appreciate their advantages.1,2
References:
1. McIntyre RS, Berk M, Brietzke E, et al. Bipolar disorders. Lancet 2020; 396 (10265): 1841–1856.
2. Vieta E, Berk M, Schulze TG, et al. Bipolar disorders. Nat Rev Dis Primers 2018; 4: 18008.
3. Nierenberg AA, Agustini B, Köhler-Forsberg O, et al. Diagnosis and treatment of bipolar disorder: a review. JAMA 2023; 330 (14): 1370–1380.
4. Pacchiarotti I, Bond DJ, Baldessarini RJ, et al. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry 2013; 170 (11): 1249–1262.