Antidepressants and antipsychotics in the long-term treatment of bipolar disorder

Antidepressants and antipsychotics are frequently used as mood stabilizers in the treatment of bipolar disorder. As common as these agents appear to be in bipolar treatment, the literature contains little research on their efficacy and safety in the long term. Most of the available literature on long-term antidepressant treatment focuses on tricyclic antidepressants, which have been shown to induce mania or hypomania. Rapid cycling is another side effect that is associated with antidepressant treatment in bipolar disorder. Antidepressants do not appear to be any more effective than mood stabilizers in treating bipolar depression. Conventional antipsychotics in depot formulations have been shown to be an effective treatment, but conventional antipsychotics may cause tardive dyskinesia. The novel antipsychotics clozapine, risperidone, and olanzapine appear to be efficacious; however, their side effect profiles include agranulocytosis and weight gain. Given the frequency with which antidepressants and antipsychotics are used in bipolar disorder and that bipolar disorder is a chronic disease requiring maintenance treatment, more research on the use of these types of agents in long-term treatment is needed. Until more evidence is available on the long-term treatment outcomes, clinicians should be aware that the adverse events associated with antidepressants and antipsychotics may outweigh the benefit, if any, of the use of these agents in bipolar disorder.