Stimulants in Bipolar Depression: Risks and Benefits

While mania is the illness hallmark, the depressive phase of bipolar disorder is the main driver of treatment resistance, functional disability, and suicidality. The 5 FDA approved anti-psychotic treatments for bipolar depression represent an important mile-stone for a clinical evidence base, but new ways of framing and rethinking care management for the depressive phase in bipolar disorder are needed. This article reviews the controversy surrounding the use of stimulants for bipolar depression. We summarize approved recommendations, discuss mechanisms of action, and compare risks and benefits to provide a new perspective and direction as how to individualize care and consider novel treatment strategies for patients with bipolar depression.