Treatment of BDII may place the physician in difficulty because of the treatment resistence.

2 male patients 48 and 52 years old diagnosed with BDII (according to DSM IV) lastest episode, major depressive episode, with a poor or partial response to long-term treatment with antidepressant, mood stabilizer and sometimes antipsychotic drugs during the presence of psychotic symptoms.

During last year their treatment was: Paroxetine 40mg/ 2x day and Lamotrigine 150mg/day. Because of the lack of response the treatment was changed as follows:

Remove of lamotrigine; decrease of paroxetine to 20 mg; adding Aripiprazole 15 mg.

BPRS, HAMD and CGI-severity were used to evaluate their symptoms and gravity.

After 2 weeks of treatment significant improvement was noticed. This includes depressive and psychotic symptoms, sleep, anxiety and cognitive symptoms. Increase of professional performance.

After using this combination, they started psychosocial rehabilitation program. Since September 2007 their situation is stabile and there have not been noticed recurrences.

Favorable clinical results were noticed to both patients, with no noticeable adverse side effects. Aripiprazole combined with Paroxetine has improved depressive and psychotic symptoms of these patients with bipolar depression.

Our findings suggest that Aripiprazole - Paroxetine is a safe and tolerable combination; however, control trials are needed to validate our findings.