The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders has been published in the American Journal of Psychiatry. The task force commented that there is “striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder.”
Some highlights of the Task Force Recommendations:
Acute treatment
1. Adjunctive antidepressants may be used for an acute bipolar I or II depressive episode if there is a history of previous positive response to antidepressants.
2. Adjunctive antidepressants should be avoided for an acute bipolar I or II depressive episode with two or more concomitant core manic symptoms in the presence of psychomotor agitation or rapid cycling.
Maintenance treatment
Adjunctive antidepressants with adjunctive antidepressants may be considered if a patient relapses into a depressive episode after stopping antidepressant therapy.
Monotherapy with antidepressants in Bipolar I should be avoided.
Switch to mania, hypomania, or mixed states and rapid cycling
Bipolar patients starting antidepressants should be closely monitored for signs of hypomania or mania and increased psychomotor agitation, in which case antidepressants should be discontinued.
The task force concluded that because of limited data, no broad endorsements were issued but it acknowledged that some bipolar patients may benefit from antidepressants. When commenting about safety, the report commented that “serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors.” Both the severity and frequency of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. And, antidepressants should be prescribed only as an adjunct to mood-stabilizing medications in bipolar I patients.
