Switching, induction of rapid cycling, and increased suicidality with antidepressants in bipolar patients: fact or overinterpretation?
Antidepressants constitute a central cornerstone in the treatment of depressive syndromes. In bipolar patients, however, there is an ongoing controversy about their usefulness for at least 3 decades. Early reports, mainly concerning tricyclic antidepressants, have repeatedly pointed toward unfavorable side effects on the course of the disorder, namely switching into (hypo)mania, induction of rapid cycling, and increased risk of suicide. Most evidence for both unfavorable and favorable effects has been deducted, thus far, from small studies with methodological flaws. More substantiated evidence only recently became available. From this it appears that, at least, the switch risk, and perhaps also the risk for rapid cycling and new-onset suicidality have been overinterpreted. At the same time, these new data raise doubt about the efficacy of antidepressants as a primary-treatment choice in bipolar depression.
University of Newcastle Institute of Neuroscience, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK. Heinz.Grunze@ncl.ac.uk
Heinz C R
HC
Grunze
D000339:Affect / Q000187:drug effects; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D008134:Long-Term Care; D012307:Risk Factors; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data; D016896:Treatment Outcome
D000928:Antidepressive Agents