Major depressive episodes are the main features of bipolar disorder (BD) and finding an efficient therapy represents a tough challenge especially when BD associates diabetes mellitus (DM). Atypical antipsychotics proved efficacy in monotherapy and more so in association with mood stabilizers, but choosing the atypical antipsychotic requires special cautions due to metabolic adverse effects.

To choose a therapeutic scheme that improves rapidly acute depressive symptoms and has a good endocrine-metabolic tolerability.

Male BD patient, 49 years old, hospitalized for a major depressive episode while taking poly-pharmacological treatment. The patient also has DM for which he takes two oral anti-diabetics. When inpatient, he had persistent hyperglycemia (>250mg/dl). DM's complications (poly-neuropathy, myocardial and retinal angiopathy) and diabetic status oriented us choosing quetiapine (600mg/day) for both antidepressive effect and its safe metabolic profile. We used as adjuvant valproat (1000mg/day). Antidiabetic medication was adjusted following the clinical outcome. Instruments: depression (MADRS), mania (YMRS), CGI-BP, diabetes (glycemia, HbA1c, glycosuria, body weight, ECG), adverse events and relapse (follow-up 6 months). The evaluations were performed weekly during hospitalization (6 weeks) and then monthly.

Quetiapine and valproat therapy led to depressive symptoms remission (MADRS <50% vs. baseline). At the same time, the metabolic effects were minimal. DM was compensated (glycemia <120mg/dl). These results maintained till the end of the follow-up period.

Acareful option for treatment and monitoring of BD associated with DM is necessary to obtain an optimal therapeutic response and to maintain remission for a longer period of time.