Use of Antidepressants in the Treatment of Bipolar Disorder

Bouts of depression are the most frequent cause of disability among patients with bipolar disorder and, as a result, bipolar patients are often prescribed antidepressants in addition to mood stabilizers. However the actual effectiveness and safety of antidepressant use in bipolar depression has not been well studied (Sachs et al. 2007). A new study suggests that, for those with Bipolar Disorder, antidepressants may not be a useful addition to the mood stabilizing drug regimen.

Cautious Use of Antidepressants

Psychiatrists are sometimes wary about prescribing antidepressants in addition to mood stabilizing drugs due to concern over the potential of elevating a bipolar patient's mood to the point of spawning a manic episode.

Without a large body of data to evaluate the adjunctive use of antidepressants in those with bipolar disorder, the question of whether antidepressants really provide any additional benefit (or harm) remains unresolved (Sachs et al. 2007).

New Study of Concurrent Use of Antidepressants & Mood Stabilizers

Research appearing in the April 2007 issue of the New England Journal of Medicine set out to examine the efficacy of concomitant use of antidepressants with mood stabilizing drugs in a population of patients with bipolar disorder.

Study Methods:

This double-blind placebo-controlled study ran for 26 weeks. Nearly 400 subjects were enrolled, approximately half of which received a mood stabilizer plus adjunctive antidepressant therapy, while the other half received a mood stabilizer plus a matching placebo

To assess the patients' status, a clinical monitoring form adapted from the mood-disorder modules of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders was used at all follow-up interviews.

The researchers were interested in assessing the percentage of subjects in each treatment group that ultimately met the criterion for a durable recovery (eight consecutive weeks of euthymia, a normal, non-depressed, reasonably positive mood). The researchers also assessed rates of treatment-emergent affective switch (a switch to mania or hypomania early in the course of treatment).

Study Results:

Results indicated that those patients receiving mood stabilizers did marginally better than those receiving a placebo, however the difference between the two groups was not large enough to be statistically significant. The findings also suggested that those receiving antidepressants were no more likely to become manic or hypomanic than those receiving the placebo.

Antidepressants No Better Than Mood Stabilizers Alone

The researchers concluded that the use of standard antidepressant medication in combination with mood stabilizers was no more effective than the use of mood stabilizers alone. However, the investigators point out that longer-term studies are needed to fully assess the benefits and risks of antidepressant therapy for patients with bipolar disorder.

Sources

American Psychiatric Association (200) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

Sachs, G. Nierenberg, A., Calabrese, J., Marangell, L. et al. (2007). Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression. The New England Journal of Medicine.

* This article is not meant to be used to treat bipolar or any other mental disorder. If you are suffering psychologically please see a mental health professional.