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The Doctor's Channel
Joseph F Goldberg, MD posted:
Here's another clip, addressing the debate around over versus under diagnosis of bipolar disorder: .

- Dr. G.
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snowyowl33 responded:
Ok, so I watched them all!.... Now I have a question... You spoke mostly about the Manic side of BP and it's meds, what are your recommendations regarding people who's main feature in BP is the depressive side?

Joseph F Goldberg, MD replied to snowyowl33's response:
Hi Snowy,
Looks like The Doctor's Channel hasn't yet posted all the video that was shot. The only 2 FDA-approved medicines for bipolar depression are Seroquel or Symbyax. No antidepressants per se are FDA-approved for bipolar depression -- some have been studied and found to work no better than a placebo (notably, Paxil), some have been studied and found to work about the same as lithium or Depakote alone (notably, Wellbutrin or Paxil), and most have not been studied in comparison to a placebo at all (Lexapro, Effexor, Pristiq, Remeron, Cymbalta, Zoloft, Celexa, Prozac with anything other than Zyprexa). So, traditional antidepressants may be useful for bipolar depression, but they have not been well-established. Yet doctors and patients alike assume that they treat bipolar depression the same as unipolar depression -- same notion as thinking an antibiotic treats all forms of bronchitis (bacterial, viral, fungal.....). Strangely, most psychiatrists don't seem to know, or care, that Seroquel or Symbyax are the only 2 FDA-approved drugs for bipolar depression, and instead seem wedded to their own beliefs that other medicines may work better.
Apart from Seroquel or Symbyax, there are some data to support the use of Lamictal, especially when combined with lithium. If antidepressants are used, Wellbutrin is among the better-studied ones (but again, data show that adding it to lithium or Depakote does not make for a higher response rate than using lithium or Depakote alone). There are many "novel" treatments that have been studied and shown to work better than placebos for bipolar depression -- among them, the stimulalnt Provigil; the Parkinson's drug Mirapex; and the ALS drug riluzole. Abilify and Geodon and Risperdal and Consta all have been shown NOT to be any better than a placebo for treating bipolar depression.

Bipolar depression unfortunately remains one of the harder aspects of the illness to treat, largely not because of the risk that antidepressants throw people into mania (far rarer than we once thought), but because they often simply don't work very well.

- Dr. G.
snowyowl33 replied to Joseph F Goldberg, MD's response:
Dear Doc,

Ok, let me throw this thought at you, do you think the reason that many p doctors don't necessarily just blindly go with FDA approved drugs ( example - for depression ), and perhaps use more of the "off label" drugs because of what they see and experience with "real" patients in their practice on a day to day basis, rather than paperwork from drug reps and Big Pharma? (I'm not trashing Pharma co's, I just think they wield too much power)... (my opinion..)

snowyowl33 replied to snowyowl33's response:
PS... I'm curious as I thought prozac had been FDA approved for depression... or is that other than BP depression?

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Joseph F. Goldberg, MD, is a Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. He also maintains a private prac...More

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