Further bipolar depression studies of similar duration have supported quetiapine’s efficacy [McElroy et al. 2010; Young et al. 2010; Thase et al. 2006; Calabrese et al. 2005]. Suppes and colleagues recently undertook an 8-week RCT of acute depression in 418 patients with bipolar depression, and showed a statistically significant advantage to the extended release (XL) formulation (single dose, 300 mg/day) compared with placebo at weeks 1 and 8 (p<0.001) [Suppes et al. 2010]. This longer acting formulation has the natural attraction of single daily dosing Inhibitors,research,lifescience,medical with the likelihood of improved medication concordance, although there are cost implications associated with this

newer drug. Aripiprazole, with the unique pharmacodynamic profile of a partial dopamine, 5HT1A and 5HT2A antagonist, has established roles in acute and maintenance treatment of manic states [Fagiolini et al. 2011] and augmenting the treatment of unipolar depression [Marcus et al. 2008]. However, it has shown a lack of efficacy in both acute management Inhibitors,research,lifescience,medical and maintenance treatment of bipolar depression [Fountoulakis et al. 2010]. A clinical review by Yatham [2011] highlighted some Inhibitors,research,lifescience,medical improvement over placebo in the initial reduction of depressive symptoms, but not to statistically significant levels by the trial endpoints, and there was no reduction in depressive relapse rates. Thus, there is good evidence

for the Inhibitors,research,lifescience,medical use of olanzapine and quetiapine but no clear role for aripiprazole. There is growing evidence for quetiapine XL, although this might also reflect bias because the trials were

sponsored by industry. Conclusion BPADs are common and debilitating, bipolar depression constituting the bulk of the psychosocial burden for patients. Bipolar depression can be difficult to diagnose Inhibitors,research,lifescience,medical and the evidence suggests that a significant number of patients in primary and secondary care remain mislabelled as having unipolar depression. This can lead to protracted periods before the correct diagnosis is made, with subsequent selleck chemical potential worsening disability and, indeed, iatrogenic Linifanib (ABT-869) deterioration from inappropriate treatments. There is an interesting disconnect between this and an apparent rapid rise in the rates of diagnosis of BPADs in clinical practice [Moreno et al. 2007], and there is popular media concern about overdiagnosis and the alleged influence of celebrity culture on self-diagnosis [Chan and Sireling, 2010]. A core pharmacological problem is our inadequate understanding of the neurobiology of bipolar illnesses. There is no clear corresponding neurotransmitter system or agreed pathway of dysfunction to model and therapeutically target, as occurs in unipolar depression and schizophrenia, although such theories are themselves heavily criticised and are fundamentally simplifications of more complex biological processes.