Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline.
BACKGROUND
Few studies have examined the relative risks of switching into hypomania or mania associated with second-generation antidepressant drugs in bipolar depression.


OBJECTIVE
To examine the relative acute effects of bupropion, sertraline and venlafaxine as adjuncts to mood stabilisers.


METHODS
In a 10-week trial, participants receiving out-patient treatment for bipolar disorder (stratified for rapid cycling) were randomly treated with a flexible dose of one of the antidepressants, or their respective matching placebos, as adjuncts to mood stabilisers.


RESULTS
A total of 174 adults with bipolar disorder I, II or not otherwise specified, currently in the depressed phase, were included. All three antidepressants were associated with a similar range of acute response (49-53%) and remission (34-41%). There was a significantly increased risk of switches into hypomania or mania in participants treated with venlafaxine compared with bupropion or sertraline.


CONCLUSIONS
More caution appears indicated in the use of venlafaxine rather than bupropion or sertraline in the adjunctive treatment of bipolar depression, especially if there is a prior history of rapid cycling.
Post
R M
RM
Department of Health and Human Services, National Institute of Mental Health, Bethesda, Maryland, USA. postr@mail.nih.gov
Altshuler
L L
LL
Leverich
G S
GS
Frye
M A
MA
Nolen
W A
WA
Kupka
R W
RW
Suppes
T
T
McElroy
S
S
Keck
P E
PE
Denicoff
K D
KD
Grunze
H
H
Walden
J
J
Kitchen
C M R
CM
Mintz
J
J
D000277:Adjuvants, Pharmaceutic / Q000009:adverse effects; D000328:Adult; D000339:Affect; D000928:Antidepressive Agents / Q000009:adverse effects*; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D016642:Bupropion / Q000009:adverse effects*; D003511:Cyclohexanols / Q000009:adverse effects*; D003866:Depressive Disorder / Q000139:chemically induced; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D020280:Sertraline / Q000009:adverse effects*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
D000277:Adjuvants, Pharmaceutic; D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D016642:Bupropion; D000069470:Venlafaxine Hydrochloride; D020280:Sertraline