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An update on antidepressant use in bipolar depression
Michelle M Sidor1, Glenda M MacQueen
1Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Current Psychiatry Reports
|October 16, 2012
Summary
Treating bipolar depression with antidepressants is challenging. Recent high-quality trials show limited efficacy and potential risks, questioning their routine use for bipolar depression.
Area of Science:
- Psychiatry
- Clinical Pharmacology
- Mood Disorders
Background:
- Bipolar depression treatment is complex, with ongoing debate regarding antidepressant efficacy.
- Antidepressant use in bipolar disorder carries risks of affective switch and destabilization.
Purpose of the Study:
- To evaluate the current evidence on antidepressant efficacy and safety in bipolar depression.
- To inform rational prescribing practices for antidepressants in bipolar disorder.
Main Methods:
- Review of recent high-quality randomized controlled trials (RCTs) in bipolar depression.
- Analysis of meta-analyses and earlier studies on antidepressant use in bipolar disorder.
Main Results:
- Recent high-quality RCTs generally do not demonstrate antidepressant efficacy for bipolar depression.
- The precise risk of affective switch and long-term destabilization remains uncertain.
- Maintenance antidepressant therapy shows a poor risk-benefit ratio in bipolar disorder.
Conclusions:
- Antidepressants lack demonstrated efficacy for bipolar depression based on current high-quality evidence.
- The risk-benefit profile of antidepressant maintenance therapy is unfavorable.
- Future research should identify patient subgroups who may benefit from antidepressants for bipolar depression.
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