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Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline
R M Post1, L L Altshuler, G S Leverich
1Department of Health and Human Services, National Institute of Mental Health, Bethesda, Maryland, USA. postr@mail.nih.gov
Background:
Few studies have examined the relative risks of switching into hypomania or mania associated with second-generation antidepressant drugs in bipolar depression.
Aims:
To examine the relative acute effects of bupropion, sertraline and venlafaxine as adjuncts to mood stabilisers.
Method:
In a 10-week trial, participants receiving out-patient treatment for bipolar disorder (stratified for rapid cycling) were randomly treated with a flexible dose of one of the antidepressants, or their respective matching placebos, as adjuncts to mood stabilisers.
Results:
A total of 174 adults with bipolar disorder I, II or not otherwise specified, currently in the depressed phase, were included. All three antidepressants were associated with a similar range of acute response (49-53%) and remission (34-41%). There was a significantly increased risk of switches into hypomania or mania in participants treated with venlafaxine compared with bupropion or sertraline.
Conclusions:
More caution appears indicated in the use of venlafaxine rather than bupropion or sertraline in the adjunctive treatment of bipolar depression, especially if there is a prior history of rapid cycling.
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