Bibliographic information
Recommendation
Fluoxetine, olanzapine, quetiapine, valproic acid (sodium valproate) or venlafaxine should be considered for adults with bipolar depression. If fluoxetine or venlafaxine are chosen, they should be co-administered with a mood stabilizer (namely quetiapine, olanzapine, carbamazepine, valproic acid [sodium valproate], lithium).
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
Remarks y Please refer to recommendation PSY8 to find further information on the recommendations for mood stabilizer and antipsychotic use in maintenance treatment.
Implementation considerations y People living with bipolar disorders should be involved in medicine choice in a supported decision-making process. y Acquisition costs can differ substantially and also throughout the world. y Lithium carbonate, sodium valproate (valproic acid), carbamazepine and quetiapine (therapeutic alternatives: aripiprazole, olanzapine, paliperidone) are available in the WHO EML (13). y Antidepressant treatment should begin at a low dose and be increased gradually if necessary. y Individuals should be monitored carefully for early signs of manic symptoms. Antidepressants should be stopped soon after remission of depressive symptoms, while mood stabilizer should be continued.