An update on antidepressant use in bipolar depression.
The effective treatment of depression in people with bipolar disorder remains a clinical challenge. The role of antidepressant medication in treating bipolar depression has been controversial. While early studies and meta-analyses supported a role for antidepressant medication, more recent, high quality randomized controlled trials in bipolar depression have generally not demonstrated efficacy for antidepressant medications. Although the risk of affective switch and long-term de-stabilization remains a concern when using antidepressant medications in bipolar disorder, the magnitude of this risk has been difficult to ascertain with confidence. Maintenance use of antidepressant medication has generally not demonstrated a favorable risk-benefit ratio. Future studies should explore the patient characteristics and response patterns that predict a more favorable response profile to antidepressants amongst patients with bipolar disorder so that the medications can be rationally used in those who are most likely to benefit.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Michelle M
MM
Sidor
Glenda M
GM
MacQueen
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D000075202:Contraindications; D006801:Humans; D017410:Practice Guidelines as Topic; D012306:Risk; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents