The International Society for Bipolar Disorders recently released the findings of a task force on the use of antidepressants in Bipolar Disorder. The evidence continues to accumulate that antidepressants alone and in combination with mood stabilizers have a very small role if any, in the pharmacological management of bipolar depression. There is increasing acknowledgement that antidepressants can be harmful. Antidepressants can lead to longterm mood instability, cycle acceleration, mood switching, mixed states and increased risk of suicide.
The results summary of the task force appears quite clear:
"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..."
However the conclusion summary is a little more ambiguous:
"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...."
Undoubtedly this was the result of the need to reach
consensus among several dozen international experts.It remains very difficult for some psychiatrists to
concede that antidepressants do more harm than
good because this is superficially counterintuitive. It is also hard to admit that one's longstanding clinical
practice may have been erroneous.
The International Society for Bipolar Disorders (ISBD) task force report on
antidepressant use in bipolar disorders.
Am J Psychiatry. 2013 Nov 1;170(11):1249-62