Placebo control showed a pronounced efficacy of modern drugs – selective serotonin reuptake inhibitors. Moreover, the exacerbation of the disease (in rather rare cases) during their intake occurs with an equally low frequency, regardless of whether the patient took the drug, or a dummy-placebo, whether he received treatment from a psychotherapist.
Antidepressants should be prescribed in a psychiatric hospital for the treatment of bipolar depression in a strictly differentiated manner, with the obligatory consideration by a psychiatrist of the individual characteristics of the course of the disease. If we apply an undifferentiated approach, then depression goes away only in one in five patients. Even if it (depression), it would seem, was arrested (without taking into account individual nuances), then after about four months, the same amount (twenty percent) reappears, or after three months MS (manic state) develops . Uncontrolled intake of antidepressants (which many patients outside a psychiatric hospital do) can lead to a worsening of the course of the disease, sudden and rapid changes in its phases.
An important goal of treating bipolar depression, therefore, is to prevent the illness from progressing into the next (manic) phase. But the period for taking medications in a psychiatric hospital should always be as limited as possible. The modern (most effective) combinations of drugs are recommended by psychiatrists as follows:
Scheme 1: A combination of normotimics (sodium valproate , lithium preparations, carbamazepine , lamotrigine ), or monotherapy with any of the above.
Scheme 2: The listed normotimics in combination with a selective serotonin reuptake inhibitor (the latter for a short period).
Scheme 3: Normotimiki in combination with antidepressants of various groups and (if depressing -bredovogo syndrome) antipsychotic drugs.
If any drug (scheme) is ineffective, or leads to a rapid transition of depression to a manic state, in the future they are generally not recommended to be used for this patient during the therapy of bipolar depression. It is the normotimics that are, according to modern concepts, the means of choice in the treatment of bipolar depression, despite the fact that they are somewhat weaker than antidepressants. The question of the use of lithium preparations in a psychiatric hospital is currently debatable . This is due to the fact that, according to some studies, in the treatment of bipolar depression (BD), lithium persistently helps in a third of all cases of its appointment. And according to other studies, lithium, in combination with antidepressants (seventy-day course), compared with the group of patients receiving only lithium and the group taking only placebo, does not have any advantages . The final word on this issue can be made by the psychotherapist working with this particular patient.