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Address correspondence to Frederick T. Lewis, DO, Deputy Director of Research, CNS Clinical Research Group, 8100 Royal Palm Blvd, Coral Springs, FL 33065-5733.E-mail: flewisdo{at}bellsouth.net

With the recent awareness of the bipolar spectrum, the interest and concern of physicians regarding the depressive side of bipolar disorder has emerged. Depression is the modal phase of bipolar disorder, as well as the phase that imparts the greatest risk for suicide. Despite these realities, little is known about the management of bipolar depression and much of what is known is complicated by conflicting reports regarding the use of antidepressants as either short- or long-term treatment modalities. This fear among physicians of complicating a patient's course secondary to antidepressant use combined with the fact that presently available mood stabilizers are less than reliable antidepressants has resulted in far more questions about management than answers. This article explores the clinical issues involving the depressive states, reviews some of the emerging data, and, it is hoped, lends some guidance regarding treatment options.

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