Evidencebased behandelingen van therapieresistente bipolaire depressie*

Objective

To present an overview of all available randomized trials on treatment strategies in patients with medication-resistant bipolar depression, a common clinical problem.

Design

Systematic review.

Method

We carried out a Medline search for publications from 1966 to 2012 using the search terms ‘treatment resistance’ or ‘treatment refractory’, ‘bipolar depression’ and ‘bipolar disorder’, supplemented by 43 separate searches using various pharmacological agents or technical interventions as search terms.

Results

Only 7 studies met the inclusion criteria. These studies examined the efficacy of ketamine (n = 2), modafinil (n = 1), pramipexole (n = 1), lamotrigine (n = 1), inositol (n = 1), risperidone (n = 1), and electroconvulsion therapy (ECT) (n = 2).

Conclusion

Published data on treatment strategies in patients with therapy-resistant bipolar depression are extremely scarce. Although the drugs studied are very promising, most of the strategies – with the exception of ECT – remain experimental. There is an urgent need for further study in homogeneous patient samples in which the concept of treatment resistance should be clear.

Conflict of interest and financial support: disclosure forms provided by the authors are available along with the full text of this article at www.ntvg.nl, search for A6075; click on ‘Belangenverstrengeling’ (‘Conflict of interest’).