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Antidepressants in Bipolar [60 Sec Psych]

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Do they help? Do they harm? And can mood stabilizers protect patients who take them? A review of Bahji A, Ermacora D, Stephenson C, Hawken ER, Vazquez G. Comparative efficacy and tolerability of pharmacological treatments for the treatment of acute bipolar depression: A systematic review and network meta-analysis. J Affect Disord. 2020;269:154‐184. [Link]

Published On: 5/28/20

Duration: 1 minute, 43 seconds


Last time we covered a network meta-analysis of medications for bipolar depression from the Journal of Affective Disorders. I’ll cover here what the paper found about antidepressant monotherapy

A few antidepressants worked as monotherapy, particularly fluoxetine, but those were small studies many of which came from a single group, Jay Amsterdam’s. The authors cautioned against using antidepressants in the long term, because of the risk they posed to rapid cycling and mixed states in mania, but they left open the possibility of using them for 1-2 months to get someone out of the episode.

Adding further doubt to the antidepressant route, they quoted an NIMH study from 1984 that found imipramine was just as likely to cause mania when given with lithium as without. Most studies, on the other hand, have shown protective effects when mood stabilizers are used with antidepressants in bipolar, but protection is rarely 100 percent.

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