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.