Over the last two months, I have had the opportunity to work in an acute psychiatric hospital. This allowed me to gain more experience and discover new therapeutic areas, specifically bipolar disorder. It was an excellent opportunity for me to work with and learn from some of the most experienced clinicians, and one of the subjects I found particularly interesting was the controversy surrounding "The risk-benefit profile of second-generation antidepressant medications in bipolar depression regarding their efficacy and risk of mood-switching."
This medical controversy starts with the fact that the available evidence regarding the value and risks of antidepressant treatment in depressive polarity is extremely limited and many of those studies are outdated, short duration with a small number of patients included.
Additionally, several trials were methodologically flawed due to increasing the risk of bias (lack of randomization, did not include most available antidepressants and high levels of heterogeneity in the meta-analyses).
According to Canadian Network for Mood and Anxiety Treatments CANMAT 2018, bipolar disorder is a complex, recurrent mood disorder with significant morbidity and mortality, that affects 1–2% of the population, It is characterized by mood swings and energy fluctuations. In most cases, it is characterized by recurrent episodes of major depression and manic or hypomanic episodes.
Episodes of mood swings may occur rarely or multiple times a year. Some patients experience not only more depression but up to triple the time depression relative to hypomanic…!
Bipolar disorder is formally divided into several categories: bipolar I disorder, bipolar II disorder, bipolar disorder induced by medications/substances/other medical disorders, as well as categories for patients who do not meet the usual criteria
As part of my clinical practice, I regularly encountered patients with bipolar disorder who were misdiagnosed with major depression due to the nature of the bipolar disorder.
Typically, those who first experience the illness in their teens start with an index episode, which is typically depression. As a result, they experience several major depressions before experiencing their first manic episode.
In the treatment of depressive episodes, antidepressants are used as adjunctive treatment to mood stabilizers. However, there are concerns about antidepressants' efficacy, as well as the potential for them to induce hypomania or mania.
