ReviewCurrent psychiatry reports2014
Options for pharmacological treatment of refractory bipolar depression.
Review in Current psychiatry reports, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Pharmaco-psychiatry and gut microbiome: a systematic review of effects of psychotropic drugs for bipolar disorder.Microbiology (Reading, England) · 2025Pooled it
- The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder.The international journal of neuropsychopharmacology · 2020Pooled it
- Transient effects of multi-infusion ketamine augmentation on treatment-resistant depressive symptoms in patients with treatment-resistant bipolar depression - An open-label three-week pilot study.Brain and behavior · 2020Trial
- Treatment of Bipolar Depression with Deep TMS: Results from a Double-Blind, Randomized, Parallel Group, Sham-Controlled Clinical Trial.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2017Trial
- (Es)ketamine as a treatment for depressive episodes with psychotic features: systematic review.BJPsych open · 2025Review
- Pharmacological Treatment of Bipolar Depression: A Review of Observational Studies.Pharmaceuticals (Basel, Switzerland) · 2023Review
- Use of Fluphenazine in Bipolar Disorder With a History of Substance Abuse: A Report of Two Cases.Cureus · 2023Article
- Prevalence of Heavy Menstrual Bleeding and Its Associated Cognitive Risks and Predictive Factors in Women With Severe Mental Disorders.Frontiers in pharmacology · 2022Article
- Risk-to-befit ratios of consecutive antidepressants for heavy menstrual bleeding in young women with bipolar disorder or major depressive disorder.Frontiers in psychiatry · 2022Article
- Investigating the Role of Leukocyte Telomere Length in Treatment-Resistant Depression and in Response to Electroconvulsive Therapy.Journal of personalized medicine · 2021Article
- The safety and efficacy of fecal microbiota transplantation in a population with bipolar disorder during depressive episodes: study protocol for a pilot randomized controlled trial.Pilot and feasibility studies · 2021Article
- Repurposing Immunomodulatory Imide Drugs (IMiDs) in Neuropsychiatric and Neurodegenerative Disorders.Frontiers in neuroscience · 2021Review
- Disturbance of Oxidative Stress Parameters in Treatment-Resistant Bipolar Disorder and Their Association With Electroconvulsive Therapy Response.The international journal of neuropsychopharmacology · 2020Article
- Group Cognitive Behavioral Analysis System of Psychotherapy (CBASP): A Pilot Study for Bipolar Depression.Frontiers in psychiatry · 2020Article
- Ketamine in Bipolar Disorder: A Review.Neuropsychiatric disease and treatment · 2020Review
- Rapid-acting antidepressant ketamine, its metabolites and other candidates: A historical overview and future perspective.Psychiatry and clinical neurosciences · 2019Review
- Pharmacological treatment of adult bipolar disorder.Molecular psychiatry · 2019Review
- Treatment-resistant and multi-therapy-resistant criteria for bipolar depression: consensus definition.The British journal of psychiatry : the journal of mental science · 2019Article
- Re-evaluation of the interrelationships among the behavioral tests in rats exposed to chronic unpredictable mild stress.PloS one · 2017Article
- Pharmacological Approaches for Treatment-resistant Bipolar Disorder.Current neuropharmacology · 2015Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Bipolar disorders of types I and II, even when treated by currently standard options, show a marked excess of depressive morbidity. Treated, type I patients in mid-course or from the onset of illness are ill, overall, 50 % of weeks of follow-up, and 75 % of that unresolved morbidity is depressive. Currently widely held impressions are that bipolar depression typically is poorly responsive to antidepressants, that treatment-resistant depression (TRD) is characteristic of the disorder, and that risk of mania with antidepressant treatment is very high. However, none of these views is supported consistently by available research. TRD may be more prevalent in bipolar than unipolar mood disorders. Relatively intense research attention is directed toward characteristics and treatments of TRD in unipolar depression, but studies of bipolar TRD are uncommon. We found only five controlled trials, plus 10 uncontrolled trials, providing data on a total of 13 drug treatments, all of which involved one or two trials, in 87 % as add-ons to complex, uncontrolled regimens. In two controlled trials, ketamine was superior to placebo but it is short-acting and not orally active; pramipexole was weakly superior to placebo in one controlled trial; three other drugs failed to outperform controls. Other pharmacotherapies are inadequately evaluated and nonpharmacological options are virtually untested in bipolar TRD. The available research supports the view that antidepressants may be effective in bipolar depression provided that currently agitated patients are excluded, that risk of mania with antidepressants is only moderately greater than risk of spontaneous mania, and that bipolar TRD is not necessarily resistant to all treatments.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.