In the only double-blind, placebo-controlled study published in the last 30 years, paroxetine monotherapy was not more effective than placebo in treating bipolar I and II depression (McElroy et al. J Clin Psychopharmacol.
2013;170(11):1249–62.Parker G. Clinical models for managing bipolar II disorder: model I. J Clin Psychiatry. Additionally, many experts and clinicians worry greatly about the capacity of antidepressants to cause affective switching or mood destabilization.
Antidepressants in bipolar depression: much confusion, many questions, few answers.
2015;35(5):605–8.Wehr TA, Goodwin FK. 2001;63(1–3):79–83.Carvalho AF, Dimellis D, Gonda X, et al.
They were also seen as a viable option when depression was long-standing, and hypomanias were mild and restricted to the distant past. In a recent meta-analysis of the eleven studies examining the efficacy and safety of longer term antidepressants (> 4 months), antidepressants were superior to placebo in preventing depressive episodes (relative risk = 0.64, CI 0.49–0.83, p < 0.001), with or without mood stabilizers with no increase in manic/hypomanic episodes (Liu et al.
Canadian network for mood and anxiety treatments (CANMAT) and international society for bipolar disorder (ISBD) collaborative update on CANMAT guidelines for the management of patients with bipolar disorder: update 2013.
In that case, the patient usually says the medication “made my depression worse.”Hypomania is difficult to measure, both in research and practice, which partly explains the inconsistencies in this poll.1 Hypomania is a brief, mild, and partly desirable state that is far better than depression.2 Hypomania leads to more depression, mixed states, and painful life consequences.Many of my patients would agree with the second point.
2012;26(5):435–60.Schneck CD, Miklowitz DJ, Miyahar S, et al.
Both TEAS and cycle acceleration typically occur early in antidepressant treatment and can be monitored.With bipolar II patients, most experts would agree that mood stabilizers should be prescribed first, before antidepressant monotherapy (although this generalization may change as we learn more).
An update on antidepressant use in bipolar depression. Eur Psychiatry. Benefits and harms of low and high second-generation antipsychotics doses for bipolar depression: a meta-analysis.
J Clin Psychiatry. Acta Psychiatry Scand. On the other hand, most of what we know about treatment comes from studies on bipolar I. 2002;63:508–12.Viktorin A, Lichtentein P, Thase ME, et al. (The data on treating bipolar II depression specifically will be reviewed below).
J Clin Psychiatry. 2010;121:201–8.Amsterdam JD, Luo L, Shults J. Efficacy and mood conversion rate during long-term fluoxetine v. lithium monotherapy in rapid-cycling bipolar II disorder. Morbidity in 303 first-episode bipolar I disorder patients.
Efficacy and safety of long-term antidepressant treatment for bipolar disorders—a meta-analysis of randomized controlled trials. Am J Psychiatry. Int J Neuropsychopharmacol. For this reason bipolar 2 depression treatment is generally like happy hour (full of cocktails). The respondents were split on the SNRIs.
2010;167(7):792–800.Amsterdam JD, Wang G, Shults J. Venlafaxine monotherapy in bipolar type II depressed patients unresponsive to prior lithium monotherapy. 2007;58(1):85–91.Baldessarini RJ, Salvatore P, Khalsa HM, et al.
Acta Psychiatry Scand.
Lurasidone monotherapy in the treatment of bipolar I depression: a randomized, double-blind, placebo-controlled study. Most saw bipolar II as a more varied group than bipolar I, and within that group are some who respond to antidepressants. Rapid cycling in manic-depressives induced by tricyclic antidepressants. Although far from certain, it is likely that different antidepressant classes confer different vulnerability to switching (Peet Surprisingly, definitive evidence from large studies and meta-analyses that mood stabilizers diminish the risk of TEAS is lacking (Sachs et al. 2003;60:1079–88.Tohen M, Frank E, Bowden CL, et al.
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