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Review ArticleClinical Review

Strategies for Managing Depression Complicated by Bipolar Disorder, Suicidal Ideation, or Psychotic Features

Peter M. Hartmann
The Journal of the American Board of Family Practice July 1996, 9 (4) 261-269; DOI: https://doi.org/10.3122/jabfm.9.4.261
Peter M. Hartmann
MD
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Abstract

Background: Major depression, a common clinical problem that, if recognized early and treated vigorously, is often highly responsive to antidepressants and can be complicated by such features as mania, suicidal thoughts and actions, and psychosis. Suicide is one of the most serious complications of major depression.

Methods: An online search of the medical literature was used to select English-language articles addressing depression using, but not limited to, the following specific terms: “primary care,” “depressive disorders,” “bipolar disorder,” “suicide,” “psychosis,” and “antidepressants.”

Results and Conclusions: Treatment of the manic phases of bipolar disorder includes lithium or anticonvulsants. Breakthrough depression can be particularly resistant to treatment in bipolar patients, and the tricyclic antidepressants can cause patients to cycle more rapidly into the manic phase. The selective serotonin reuptake inhibitors (SSRIs) and bupropion are less likely to cause rapid cycling in bipolar disorder. Depressed patients with suicidal tendencies should be closely monitored and given full doses of antidepressant medications. The SSRIs lessen suicidal tendencies and, importantly, are markedly safer than the tricyclic antidepressants when taken in an overdose. Depressed patients can also become psychotic, exhibiting mood-congruent delusions. Combination therapy with antidepressant and antipsychotic medications is often necessary. Some physicians prefer to hospitalize patients with psychotic depression. Depression can be a complex and multifaceted disorder that requires careful diagnosis and treatment plans.

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The Journal of the American Board of Family     Practice: 9 (4)
The Journal of the American Board of Family Practice
Vol. 9, Issue 4
1 Jul 1996
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Strategies for Managing Depression Complicated by Bipolar Disorder, Suicidal Ideation, or Psychotic Features
Peter M. Hartmann
The Journal of the American Board of Family Practice Jul 1996, 9 (4) 261-269; DOI: 10.3122/jabfm.9.4.261

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Strategies for Managing Depression Complicated by Bipolar Disorder, Suicidal Ideation, or Psychotic Features
Peter M. Hartmann
The Journal of the American Board of Family Practice Jul 1996, 9 (4) 261-269; DOI: 10.3122/jabfm.9.4.261
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