The Role of Atypical Antipsychotic Therapy for Patients with Treatment- Resistant Bipolar Depression

Physicians treating patients with bipolar depression have a unique challenge when considering drug therapy. Historically, patients with bipolar depression have been treated with SSRIs or other medications commonly utilized with patients presenting with non-bipolar depression. Indeed, many of these medications are not ideal for patients suffering from bipolar depression. Recently, a class of second-generation atypical antipsychotics has emerged as an exciting new avenue for the treatment of bipolar depressive episodes. While these medications have received a wealth of empirical support for treating treatment-resistant unipolar depression, less is known about the efficacy of these medications in treating bipolar depression. Early evidence is promising, though additional trials may be warranted to more clearly delineate the role of second-generation atypical antipsychotics in treating bipolar depressive episodes. This article discusses the second-generation atypical antipsychotics that have received empirical support for use in treating depressive symptoms in patients with bipolar depression. Current FDA approvals for usage are reviewed and avenues for future work are proposed.