BACKGROUND: Bipolar disorder is a serious, chronic, and disabling mental illness with a lifetime prevalence of 4.4% in the US. Depression is the predominant clinical manifestation in bipolar disorder, with severe levels of depressive symptoms reported in 75% of the patients.

OBJECTIVES: To understand the current landscape and implications to unmet needs with the influx of emerging therapies in the Bipolar Depression (BD) arena.

METHODS: A Targeted Literature Review (TLR) identified articles in which depression is defined as a major symptom/component within bipolar disorder. The search followed the PICOS criteria and was limited to publications from the US over the last 10 years.

RESULTS: BD is associated with mortality due to high morbidity, and a 20-fold increase in suicide risk compared to the general population. Misdiagnosis is one of the key challenges in Bipolar Depression, as roughly 2 out of 3 BD patients are incorrectly diagnosed with Major Depressive Disorder (MDD). Antipsychotics are the foundation of treatment in bipolar depression. Utilization analysis of oral branded antipsychotics demonstrated that Seroquel/XR® is the mostly commonly used, followed by Latuda Vraylar® and Symbax®. Despite high utilization in current practice, antipsychotics are associated with adverse metabolic and neurological effects, leaving an unmet need within the treatment algorithm. Approximately 30 therapies indicated for Bipolar Depression are in Phase III, which will have varying levels of impact on this devastating disease.

CONCLUSIONS: Depression is an intrinsic component of Bipolar Disorder, making it difficult for providers to identify and often leading to misdiagnosis with other psychiatric disorders. The current standard of care is associated with limited efficacy and numerous adverse effects. With prevalence continuing to rise, it is incumbent for relevant stakeholders to develop methods to distinguish bipolar depression and manage the disease with increased efficacy and safety to reduce morbidity and mortality.