Treatment guidelines for acute bipolar depression

Bipolar depression is the facet of bipolar disorder most difficult to treat and responsible for most of the disability related to bipolar disorder. Despite supposedly being evidence-based, guidelines for the treatment of bipolar disorder vary significantly across committees or working groups. While the usefulness quetiapine, the olanzapine-fluoxetine combination, lithium, valproic and carbamazepine is widely accepted, it is clearly stated that in bipolar depression antidepressants should be used only in combination with antimanic agents in order to avoid switching of phases. However there is still controversy over the usefulness of the various agents and modalities mainly due to little and poor evidence and conflicting opinions.