Antidepressant treatment in bipolar versus unipolar depression.
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.
Ghaemi
S Nassir
SN
Department of Psychiatry, Cambridge Hospital, MA 02139, USA. ghaemi@hms.harvard.edu
Rosenquist
Klara J
KJ
Ko
James Y
JY
Baldassano
Claudia F
CF
Kontos
Nicholas J
NJ
Baldessarini
Ross J
RJ
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
D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors