Table 45-6 Overview of antidepressants used in the treatment of bipolar depression

Table 45-6 Overview of antidepressants used in the treatment of bipolar depression
Drug	Daily dosage	Efficacy	Comments
Lithium	To achieve plasma level of 0.6-1.2 mmol/L	Lithium > placebo; Lithium < standard antidepressants	Least risk of switch into mania.
Imipramine	150-300 mg		Rate of affective switch same as that observed for MAOI but perhaps more intense.
Desipramine	150-300 mg		Rate of affective switch greater than that observed for bupropion.
Maprotiline	150-225 mg	Equivalent to imipramine
Moclobemide	300-600 mg	Equivalent to imipramine	Not available in U.S.
Tranylcypromine	20-90 mg	Superior to imipramine	Rate of affective switch same as that observed for imipramine but perhaps less intense.
Fluoxetine	10-60 mg	Superior to imipramine	Rate of affective switch greater than that observed for imipramine.
Bupropion	150-450 mg	Equivalent to desipramine	Rate of affective switch significantly less than that observed for desipramine.
Note. MAOI = monoamine oxidase inhibitor.