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The use and effectiveness of antidepressants as a Bipolar medication during depressive episodes in patients with bipolar illness are not fully understood. Researchers retrospectively reviewed the charts of 165 patients who attended a university-hospital bipolar clinic (from January 1998 to December 2000) to identify bipolar patients who met DSM-IV criteria for major depressive episodes (the clinic systematically used standardized rating and diagnostic scales).
Fifty bipolar patients with depressive episodes were identified; 33 had been treated with antidepressants (SSRIs, bupropion, venlafaxine, mirtazapine, stimulants, or monoamine oxidase inhibitors), and 17 had not received such Bipolar medication. Most patients had been treated with mood stabilizers, and a significant number in each group had received some form of psychotherapy.
Survival analyses showed no significant difference between the antidepressant-user and antidepressant-nonuser groups in length of depressive episodes (median length, 72 days vs. 56 days). The switch rate to mania was also similar in the 2 groups (about 16%). No one type of antidepressant provided any specific advantage.
Because this retrospective study used a nonrandomized population, the patients who were not treated with antidepressants as a bipolar medication may have been different in some way (e.g., more optimal mood-stabilizer treatment) from those who received antidepressants.
Still, the results are consistent with many other studies that show that even the most modern antidepressants do little to shorten depressive episodes in patients with bipolar illness. Clinicians should probably discuss with patients the fact that these depressive episodes, whether treated or not, may last 2 to 3 months
Click here for more on Bipolar medication by the Journal Watch Psychiatry.
The above article on Bipolar medication is reprinted with the permission of Journal Watch Psychiatry.
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