[Are there substantial reasons for contraindicating antidepressants in bipolar disorder? Part III. The alternatives!].
After having described depressive symptoms along the course and different subtypes of bipolar disorder the authors focus on pharmacological alternatives to antidepressant medication in bipolar depression. In doing so, they review the newest literature on efficacy of antidepressants and compare effect size of the different alternatives like antipsychotics and mood stabilizers to those of antidepressants. Efficacy of antidepressants in bipolar depression is still discussed controversially, as scientific evidence, is as far as available, weak. Severity of depressive symptoms should define, wether or not antidepressants in comparison to alternative agents like antipsychotics or mood stabilizers should be implemented. According to a balanced analysis of pro's and con's antidepressants may be used in minor to medium depressive symptoms as well. For clinical safety reasons, and not due to scientific evidence, an antimanic agent should be implemented in addition to an antidepressant. Because of clinical wisdom, in patients with mixed episodes or rapid cycling antidepressants should be avoided.
Hausmann
Armand
A
Universitätsklinik für Psychiatrie, Medizinische Universiätt Innsbruck. armand.hausmann@i-med.ac.at
Fuchs
Martin
M
Walpoth
Michaela
M
Hörtnagl
Christine
C
Adami
Petra
P
Conca
Andreas
A
D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D000075202:Contraindications; D004359:Drug Therapy, Combination; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000927:Anticonvulsants; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents