Background
Bipolar depression
First line/classic treatments for acute bipolar depression
Antidepressants in bipolar depression: conceptual concerns
Antidepressants for acute bipolar depression: a summary of the efficacy data and meta-analyses
Antidepressants for acute bipolar depression: a summary of the switch data and meta-analyses
Cycle acceleration from antidepressants
Treating bipolar II depression with antidepressants
Long term treatment with antidepressants in bipolar disorder
Antidepressants in bipolar disorder: a clinical perspective
-
The efficacy of antidepressants in bipolar depression remains unproven.
-
When added to mood stabilizers, antidepressants are not associated with increased switch (TEAS).
-
No consistent evidence has demonstrated cycle acceleration in bipolar patients on modern antidepressants (especially with mood stabilizer co-treatment).
-
Bipolar II patients may be treated safely (at least in the short term) with antidepressants.
-
A subset of bipolar patients, both bipolar I and II, will need a maintenance regimen of mood stabilizers plus antidepressants and will not show mood instability with this regimen.
Bipolar I vs. bipolar II |
Mixed depressive features |
Rapid cycling |
Antidepressant subtype-TCAs > venlafaxine (?other SNRIs) > SSRIs or bupropion |
Substance abuse history, especially stimulants |