Antidepressants in Bipolar [60 Sec Psych]

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 (https://pubmed.ncbi.nlm.nih.gov/32339131/)]

Published On: 5/28/20

Duration: 1 minute, 43 seconds

Transcript:

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, but 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. This goes against the conventional wisdom that antidepressants are safe as long as a mood stabilizer is on board. I sympathize with that conclusion. Antidepressants seem to work in a minority of bipolar patients, but it’s hard to predict who they are. For many, they make the condition worse.  I’ve always been skeptical of the idea that an unsafe treatment is OK as long as it’s given with a protective one. Car accidents aren’t safe just because you have a seatbelt on, and filtered cigarettes do little to protect against cancer.

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