Medication for moderate to severe bipolar depressive episode

Some evidence – there is enough evidence to indicate that this can be a helpful treatment option.

There are only a few research trials on medications for bipolar depression in young people, but there are reasons to believe it is similar to bipolar depression in adults.  

In bipolar depression there is a risk that antidepressant medication can trigger episodes of mania, and so bipolar depression is treated differently to depression which is not part of bipolar disorder (sometimes called ‘unipolar depression’).    

If you are not already taking medication to treat bipolar disorder, your professional could suggest that you try taking both fluoxetine and olanzapine together, or other medications on their own, such as quetiapine or olanzapine.If you don’t find these medications helpful, your doctor might prescribe you lamotrigine. However lamotrigine can cause a serious rash in children and young people and so your dose has to be increased very slowly, meaning it’s slow to have an effect on your bipolar depression.  

If you are already taking medication to treat your bipolar disorder (e.g. lithium or sodium valproate), your professional might suggest increasing your dose of lithium or trying one of the other medications mentioned here.

Stopping antipsychotic medications 

If antipsychotics are used as a treatment for bipolar depression they should not be used for longer than 12 weeks. Your doctor is likely to gradually reduce the dose before stopping it. If you are taking antipsychotic medication longer-term to prevent future episodes, then they might be used for longer than 12 weeks.  

Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.

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