title: Antidepressant treatment in bipolar versus unipolar depression.
abstract: OBJECTIVE
  Antidepressant responses were compared in DSM-IV bipolar and unipolar depression.
  
  
  METHODS
  The authors analyzed clinical records for outcomes of antidepressant trials for 41 patients with bipolar depression and 37 with unipolar depression, similar in age and sex distribution.
  
  
  RESULTS
  Short-term nonresponse was more frequent in bipolar (51.3%) than unipolar (31.6%) depression. Manic switching occurred only in bipolar depression but happened less in patients taking mood stabilizers (31.6% versus 84.2%). Cycle acceleration occurred only in bipolar depression (25.6%), with new rapid cycling in 32.1%. Late response loss (tolerance) was 3.4 times as frequent, and withdrawal relapse into depression was 4.7 times less frequent, in bipolar as in unipolar depression. Mood stabilizers did not prevent cycle acceleration, rapid cycling, or response loss. Modern antidepressants, in general, did not have lower rates of negative outcomes than tricyclic antidepressants.
  
  
  CONCLUSIONS
  The findings suggest an unfavorable cost/benefit ratio for antidepressant treatment of bipolar depression.
authors.affiliation: Department of Psychiatry, Cambridge Hospital, MA 02139, USA. ghaemi@hms.harvard.edu
authors.forename: S Nassir
authors.initials: SN
authors.lastname: Ghaemi
authors.forename: Klara J
authors.initials: KJ
authors.lastname: Rosenquist
authors.forename: James Y
authors.initials: JY
authors.lastname: Ko
authors.forename: Claudia F
authors.initials: CF
authors.lastname: Baldassano
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Kontos
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D017678:Sex Distribution
chemical_list: D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors