Table 6.
Levels of recommendation concerning adjunctive treatment for resistant acute bipolar depression and recommended dosages for medication options
| Treatment modality to add | Grading | ||
|---|---|---|---|
| In terms of efficacy | In terms of recommendation | Dosage | |
| Lamotrigine (on lithium) | 1 | 2 | Up to 200 mg/d |
| Light therapy | 1 | 1 | |
| ECT | 2 | 2 | |
| Modafinil | 2 | 2 | Up to 200 mg/d |
| Pramipexole | 2 | 2 | Up to 2.5 mg/d |
| TMS | 2 | 2 | |
| Pioglitazone | 3 | 3 | 30 mg/d |
| Amitriptyline | 4 | 4 | Up to 150 mg/d |
| Bupropion | 4 | 4 | Up to 375 mg/d |
| Clozapine | 4 | 4 | Up to 600 mg/d |
| Diltiazem | 4 | 4 | Up to 240 mg/d |
| Gabapentin | 4 | 4 | 600–2400 mg/d |
| L-sulpiride | 4 | 4 | 50–75 mg/d |
| N-acetyl cysteine | 4 | 4 | 2000 mg/d |
| Ketamine | 1 | 4 | Intravenous infusion 0.5 mg/kg |
| l-Thyroxine | 4 | 4 | 300 mcg/d |
| Lurasidone | 4 | 4 | Up to 120 mg/d |
| Omega-3 fatty acids | 4 | 4 | Various |
| Oxcarbazepine | 4 | 4 | Up to 1200 mg/d |
| Paroxetine | 4 | 4 | Up to 40 mg/d |
| Pramipexole | 4 | 4 | 3 mg/d |
| Sleep deprivation | 4 | 4 | – |
| Tranylcypromine | 4 | 4 | 30–60 mg/d |
| Venlafaxine | 4 | 4 | 75–225 mg/d |
| Agomelatine | NR | NR | |
| Aripiprazole | NR | NR | |
| Celecoxib | NR | NR | |
| DBS | NR | NR | |
| Galantamine | NR | NR | |
| Imipramine | NR | NR | |
| Inositol | NR | NR | |
| Leviracetam | NR | NR | |
| Lisdexamfetamine | NR | NR | |
| Memantine | NR | NR | |
| Pregnenolone | NR | NR | |
| S-adenosyl-L-methione | NR | NR | |
| Topiramate | NR | NR | |
| Ziprasidone | NR | NR |
Abbreviations: DBS, deep brain stimulation; ECT, electroconvulsive therapy; NR, not recommended; TMS, transcranial magnetic stimulation.