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Treating depression in patients with bipolar disorders while avoiding switches to mania remains vexing for most clinicians. Using life-chart techniques that graphically show the longitudinal course of illness, researchers conducted 2 prospective, open, naturalistic studies of mood switches in bipolar patients.
Investigators identified 42 patients with bipolar I or bipolar II disorder (mean length of illness, 23 years) who received only a single additional medication (antidepressant or mood stabilizer) to treat a depressive episode; 67 depressive episodes were studied. When episodes of depression occurred after euthymia, 63% of patients responded to treatment. However, when depressive episodes immediately followed mania or hypomania, only 28%…