title: Review of evidence for use of antidepressants in bipolar depression.
abstract: OBJECTIVE
  Depressive episodes predominate over the course of bipolar disorder and cause considerable functional impairment. Antidepressants are frequently prescribed in the treatment of bipolar depression, despite concerns about efficacy and risk of switching to mania. This review provides a critical examination of the evidence for and against the use of antidepressants in bipolar depression.
  
  
  METHODS
  English-language peer-reviewed literature and evidence-based guidelines published between January 1, 1980, and March 2014, were identified using PubMed, MEDLINE, PsycINFO/PsycLIT, and EMBASE. All searches contained the terms antidepressants, bipolar depression, depressive episodes in bipolar disorder, and treatment guidelines for bipolar depression. Meta-analyses, randomized controlled trials, systematic reviews, and practice guidelines were included. Bibliographies from these publications were used to identify additional articles of interest.
  
  
  METHODS
  Studies involving treatment of bipolar depression with antidepressant monotherapy, adjunctive use of antidepressant with a mood stabilizer, and meta-analysis of such studies combined were reviewed.
  
  
  CONCLUSIONS
  The body of evidence on the use of antidepressant monotherapy to treat patients with bipolar depression is contentious, but the recommendations from evidence-based guidelines do not support antidepressant monotherapy for bipolar depression. Only when mood stabilizer or atypical antipsychotic monotherapy has failed should adjunctive treatment with an antidepressant be considered.
authors: Department of Psychiatry, University Health Network, University of Toronto (Drs McInerney and Kennedy), and Arthur Sommer-Rotenberg Chair in Suicide Studies (Dr Kennedy) and Department of Psychiatry (Dr McInerney), St Michael's Hospital, Toronto, Ontario, Canada.
authors: Shane J
authors: SJ
authors: McInerney
authors: Department of Psychiatry, University Health Network, University of Toronto (Drs McInerney and Kennedy), and Arthur Sommer-Rotenberg Chair in Suicide Studies (Dr Kennedy) and Department of Psychiatry (Dr McInerney), St Michael's Hospital, Toronto, Ontario, Canada.
authors: Sidney H
authors: SH
authors: Kennedy