An Update on Antidepressant Use in Bipolar Depression
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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.
KeywordsBipolar disorder Major depression Bipolar depression Antidepressant Response Remission Switch Treatment outcome Prescribing guidelines Pharmacotherapy Psychiatry
The authors would like to thank Dr. David Kupfer and Dr. Holly Swartz for their thoughtful insight and discussion regarding topics of this review.
M. M. Sidor: none; G. M. MacQueen: research funding from AstraZeneca; payment for lectures including service on speakers bureaus from AstraZeneca, Bristol-Myers Squibb, Pfizer, Eli Lilly and Company, and Janssen; and payment for the development of educational presentations from the Canadian Psychiatric Association.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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