How Risky Are Antidepressants in Bipolar Disorder?
Nearly all psychiatrists agree that antidepressants can cause a person to "switch" from depression into mania (or into the milder form known as hypomania, as in Bipolar II. If those terms are mysterious, you'll find an explanation of them on this page from my website). How often does this "switch" occur? Ah, that's where the disagreement arises. By previous estimates, somewhere around 20-40% of patients with bipolar disorder who are given an antidepressant could experience such a switch.
Since mania can be dangerous, at least to important relationships and one's bank account, you would think there would be intense interest in knowing whether this switch-rate estimate was correct. If true, especially if it was up there toward 40% of all patients receiving antidepressants, you'd think that this ought to make doctors think twice about using antidepressants in patients with bipolar disorder (and patients think twice about taking them).
But no one had studied specifically how often this kind of "switching" occured. In 2004, a sophisticated re-examination of the few studies that shed light on this issue suggested that the rate could be as low as 2-4%! The authors concluded that "there is no strong reason to avoid antidepressants." (All the references for this blog-entry can be found on my webpage entitled Antidepressant Controversies, although this page is one of the most complex on my site and is geared more for doctors, whom I'm trying to convince about all this, than for patients and families, for whom most the rest of the website was written).
Ah, but now comes the first study to deliberately examine switch rates in patients with bipolar disorder, taking a mood stabilizer, who are placed on an antidepressant (Leverich and colleagues, Feb 2006). They found a 20% switch rate in patients with Bipolar II, and a 30% rate in patients with Bipolar I. In other words, the rates were much closer to our old estimates than to the very low 2-4% estimate.
The bottom line: yes, it does indeed appear that antidepressants cause switching, and it is common. Avoiding antidepressants in patients with bipolar disorder is still justified, perhaps more so since this most recent study. Fortunately, there are nine other tools with antidepressant effects, yet which are not antidepressants themselves and which do not have the capacity to make bipolar disorder worse. For a review of these options, see my webpage on the 9 antidepressants that aren't antidepressants!"
JP
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Since mania can be dangerous, at least to important relationships and one's bank account, you would think there would be intense interest in knowing whether this switch-rate estimate was correct. If true, especially if it was up there toward 40% of all patients receiving antidepressants, you'd think that this ought to make doctors think twice about using antidepressants in patients with bipolar disorder (and patients think twice about taking them).
But no one had studied specifically how often this kind of "switching" occured. In 2004, a sophisticated re-examination of the few studies that shed light on this issue suggested that the rate could be as low as 2-4%! The authors concluded that "there is no strong reason to avoid antidepressants." (All the references for this blog-entry can be found on my webpage entitled Antidepressant Controversies, although this page is one of the most complex on my site and is geared more for doctors, whom I'm trying to convince about all this, than for patients and families, for whom most the rest of the website was written).
Ah, but now comes the first study to deliberately examine switch rates in patients with bipolar disorder, taking a mood stabilizer, who are placed on an antidepressant (Leverich and colleagues, Feb 2006). They found a 20% switch rate in patients with Bipolar II, and a 30% rate in patients with Bipolar I. In other words, the rates were much closer to our old estimates than to the very low 2-4% estimate.
The bottom line: yes, it does indeed appear that antidepressants cause switching, and it is common. Avoiding antidepressants in patients with bipolar disorder is still justified, perhaps more so since this most recent study. Fortunately, there are nine other tools with antidepressant effects, yet which are not antidepressants themselves and which do not have the capacity to make bipolar disorder worse. For a review of these options, see my webpage on the 9 antidepressants that aren't antidepressants!"
JP
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