Which antidepressants flick the switch?
OBJECTIVE
The Black Dog Institute seeks to address issues of relevance to the clinical management of those with a mood disorder. This overview considers the capacity of antidepressant drugs, and particularly the new classes, to induce manic switching in depressed patients.


METHODS
Relevant literature is reviewed.


RESULTS
It is unclear whether antidepressant drugs from any of the classes induce switching in unipolar depressed patients. In bipolar depressed patients, the broad-spectrum tricyclic and monoamine oxidase inhibitor drugs present a clear risk of switching, the selective serotonin re-uptake inhibitors do not appear (at standard doses) to increase the risk, while the capacity of the dual action (serotonergic and noradrenergic) drugs to induce switching remains unestablished but may be slight.


CONCLUSIONS
As switching induced by narrow action antidepressants does not appear to present a substantive causal risk, clinicians can have confidence in prescribing certain anti-depressants for managing bipolar depression, and without any necessity to first prescribe a mood stabilizer to pre-empt switching.
Parker
Gordon
G
School of Psychiatry, University of New South Wales, and Mood Dis-orders Unit, Black Dog Institute, Randwick 2031, Australia. g.parker@unsw.edu.au
Parker
Kay
K
D000928:Antidepressive Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000188:drug therapy* / Q000523:psychology; D006801:Humans
D000928:Antidepressive Agents