Applied Evidence

A primary care guide to bipolar depression treatment

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Electroconvulsive therapy (ECT). Patients might also need referral to Psychiatry for ECT, which is recommended by ­CANMAT–ISBD and JSMD guidelines as a second-line option; by the Royal Australian and New Zealand College of Psychiatrists as a third-line option; and by BAP for cases that are resistant to conventional treatment, with or without a high risk of suicide; in pregnancy; and in life-threatening situations.15,31,32

Telemedicine. There is a considerable shortage of mental health care professionals.33,34 The fact that nearly all (96%) counties in the United States have an unmet need for prescribers of mental health services (mainly psychiatrists) makes it crucial that primary care physicians be knowledgeable and prepared to manage BD—often with infrequent psychiatry consultation or, even, without psychiatry consultation. For primary care facilities that lack access to psychiatric services, telemedicine can be used as a consultative resource.

Limited evidence allows the use of antidepressant monotherapy in select cases of bipolar depressive episodes in bipolar II, although not in bipolar I.

Psychiatric consultation using telemedicine technologies has provided significant cost savings for medical centers and decreased the likelihood of hospital admission,35 thereby alleviating health care costs and improving care, as shown in a rural Kansas county study.36 Furthermore, the burden on emergency departments in several states has been significantly reduced with psychiatric consultations via interactive telemedicine technologies.37

Mark Yassa, BS, provided editing assistance.

Nagy Youssef, MD, PhD, Medical College of Georgia at Augusta University, Department of Psychiatry and Health Behavior, 997 St. Sebastian Way, Augusta, GA 30912; [email protected].


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