title: The argument of antidepressant drugs in the treatment of bipolar depression: mixed evidence or mixed states?
abstract: BACKGROUND
  The role of antidepressant drugs in acute and maintenance treatment of bipolar depression is a matter of debate that cannot be decided from the evidence available in the current literature.
  
  
  METHODS
  This review includes two sections: in the first, important contributions from the current literature, emphasizing randomized controlled trials (RCTs) and meta-analysis, highlight current controversies and methodological issues; in the second, the impact of mixed depressive features in bipolar depression is evaluated from a psychopathological perspective.
  
  
  CONCLUSIONS
  Methodological issues may complicate evaluation of the evidence from RCTs regarding antidepressants and mixed states. Moreover, nosological constructs may also contribute to the inconclusive findings, by introducing heterogeneity in patient selection and diagnosis. Acknowledging the impact of mixed features in the course of bipolar depression, essentially by the careful reading of classical Kraepelinian contributions, could enhance clinical management. This would in turn allow a more judicious use of antidepressants, ideally helping to shed some light on the much controversial 'antidepressant-related suicidality', and help to further clarify the reasons for the current literature discordance on this topic.
authors.affiliation: University of Catania, Department of Formative Sciences, via Teatro Greco n.78, Catania, ZIP 95124, Italy. dott.fornaro@gmail.com
authors.forename: Michele
authors.initials: M
authors.lastname: Fornaro
authors.forename: Matteo
authors.initials: M
authors.lastname: Martino
authors.forename: Concetta
authors.initials: C
authors.lastname: De Pasquale
authors.forename: Driss
authors.initials: D
authors.lastname: Moussaoui
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D006801:Humans
chemical_list: D000928:Antidepressive Agents