OBJECTIVE: The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. METHOD: An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. RESULTS: 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. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. CONCLUSIONS: Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.
OBJECTIVE: The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. METHOD: An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. RESULTS: 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. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. CONCLUSIONS: Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolarpatients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar Ipatients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.
Authors: Marc Valentí; Isabella Pacchiarotti; C Mar Bonnín; Adriane R Rosa; Dina Popovic; Alessandra M A Nivoli; José Manuel Goikolea; Andrea Murru; Juan Undurraga; Francesc Colom; Eduard Vieta Journal: J Clin Psychiatry Date: 2012-02 Impact factor: 4.384
Authors: Lakshmi N Yatham; Sidney H Kennedy; Sagar V Parikh; Ayal Schaffer; Serge Beaulieu; Martin Alda; Claire O'Donovan; Glenda Macqueen; Roger S McIntyre; Verinder Sharma; Arun Ravindran; L Trevor Young; Roumen Milev; David J Bond; Benicio N Frey; Benjamin I Goldstein; Beny Lafer; Boris Birmaher; Kyooseob Ha; Willem A Nolen; Michael Berk Journal: Bipolar Disord Date: 2012-12-12 Impact factor: 6.744
Authors: Diana Khoubaeva; Mikaela Dimick; Vanessa H Timmins; Lisa M Fiksenbaum; Rachel H B Mitchell; Ayal Schaffer; Mark Sinyor; Benjamin I Goldstein Journal: Eur Child Adolesc Psychiatry Date: 2021-05-24 Impact factor: 4.785
Authors: Diego F Tavares; Martin L Myczkowski; Rodrigo L Alberto; Leandro Valiengo; Rosa M Rios; Pedro Gordon; Bernardo de Sampaio-Junior; Izio Klein; Carlos G Mansur; Marco Antonio Marcolin; Beny Lafer; Ricardo A Moreno; Wagner Gattaz; Zafiris J Daskalakis; André R Brunoni Journal: Neuropsychopharmacology Date: 2017-02-01 Impact factor: 7.853
Authors: Rachel Hershenberg; Theodore D Satterthwaite; Aylin Daldal; Natalie Katchmar; Tyler M Moore; Joseph W Kable; Daniel H Wolf Journal: J Affect Disord Date: 2016-02-16 Impact factor: 4.839
Authors: Andrea Murru; Dina Popovic; Isabella Pacchiarotti; Diego Hidalgo; Jordi León-Caballero; Eduard Vieta Journal: Curr Psychiatry Rep Date: 2015-08 Impact factor: 5.285
Authors: Andrew C Leon; Jess G Fiedorowicz; David A Solomon; Chunshan Li; William H Coryell; Jean Endicott; Jan Fawcett; Martin B Keller Journal: J Clin Psychiatry Date: 2014-07 Impact factor: 4.384
Authors: Alexander Viktorin; Eleonore Rydén; Michael E Thase; Zheng Chang; Cecilia Lundholm; Brian M D'Onofrio; Catarina Almqvist; Patrik K E Magnusson; Paul Lichtenstein; Henrik Larsson; Mikael Landén Journal: Am J Psychiatry Date: 2016-10-03 Impact factor: 18.112