The DOI matches its Crossref record; 63 of the 63 references it cites were found in a registry or an index.
Antidepressants in bipolar depression: an enduring controversy
Open accessAbstract
The proper place and the optimal use of antidepressants in treating bipolar depression continues to be an area of great interest and greater controversy with passionate opinions more common than good studies. Even the handful of meta-analyses in the area disagree with each other. Overall, the evidence that antidepressants are effective in treating bipolar depression is weak. Additionally, many experts and clinicians worry greatly about the capacity of antidepressants to cause affective switching or mood destabilization. Yet, in short term controlled studies, with most patients also taking mood stabilizers, antidepressants are not associated with switches into mania/hypomania. Evidence of cycle acceleration with antidepressants primarily reflects treatment with older antidepressants, e.g., tricyclics. Similar evidence with modern antidepressants such as selective serotonin reuptake inhibitors (SSRIs) is lacking. The key questions should not be: are antidepressants effective in bipolar depression?; And: do antidepressants worsen the course of bipolar disorder? Rather, the question should be focused on subgroups: for which patients are antidepressants helpful and safe, and for which patients will they be harmful? Predictors of affective switching with antidepressants include: bipolar I disorder (vs. bipolar II), mixed features during depression, tricyclics vs. modern antidepressants, rapid cycling and possibly a history of drug abuse, especially stimulant abuse. Additionally, a number of recent studies have demonstrated both the safety and efficacy of antidepressant monotherapy in treating bipolar II depression. Finally, a subgroup of bipolar individuals need antidepressants in addition to mood stabilizers as part of an optimal maintenance treatment regimen.
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“Also, treatment between these illnesses differs substantially and prescription of antidepressants to bipolar patients is controversial and could worsen the clinical picture [70].”
From Neutrophil-to-Lymphocyte Ratio, a Novel Inflammatory Marker, as a Predictor of Bipolar Type in Depressed Patients: A Quest for Biological Markers (2021) · cites this paper as [70]
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“Also, treatment between these illnesses differs substantially and prescription of antidepressants to bipolar patients is controversial and could worsen the clinical picture [70].”
From Neutrophil-to-Lymphocyte Ratio, a Novel Inflammatory Marker, as a Predictor of Bipolar Type in Depressed Patients: A Quest for Biological Markers (2021) · cites this paper as [70]
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Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression
Sachs, G. S., Nierenberg, A. A., Calabrese, J. R., Marangell, L. B., Wisniewski, S. R., Gyulai, L., Friedman, E. S., Bowden, C. L., Fossey, M. D., Ostacher, M. J., et al. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa064135 · Cited by 937
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Pacchiarotti, I., Bond, D. J., Baldessarini, R. J., Nolen, W. A., Grunze, H., Licht, R. W., Post, R. M., Berk, M., Goodwin, G. M., Sachs, G. S., et al. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.13020185 · Cited by 770
Antidepressant-induced mania and cycle acceleration: a controversy revisited
Altshuler, L. L., Post, R. M., Leverich, G. S., Mikalauskas, K., ROSOFF, A. S., & Ackerman, L. (1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.8.1130 · Cited by 607
Antidepressants for Bipolar Depression: A Systematic Review of Randomized, Controlled Trials
Gijsman, H. J., Geddes, J. R., Rendell, J. M., Nolen, W. A., & Goodwin, G. M. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.9.1537 · Cited by 567
Goodwin, F. K., & Jamison, K. R. (2007) · Cited by 534
Tohen, M. F., Frank, E., Bowden, C. L., Colom, F., Ghaemi, S. N., Yatham, L. N., Malhi, G. S., Calabrese, J. R., Nolen, W. A., Vieta, E., et al. (2009) · Bipolar Disorders · doi:10.1111/j.1399-5618.2009.00726.x · Cited by 527
Cited by
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Diagnosis and Treatment of Bipolar Disorder
Nierenberg, A. A., Agustini, B., Köhler‐Forsberg, O., Cusin, C., Katz, D., Sylvia, L. G., Peters, A. T., & Berk, M. (2023) · JAMA · doi:10.1001/jama.2023.18588 · Cited by 448
Bipolar depression: a major unsolved challenge
Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020) · International Journal of Bipolar Disorders · doi:10.1186/s40345-019-0160-1 · Cited by 235
Premenstrual Exacerbations of Mood Disorders: Findings and Knowledge Gaps
Kuehner, C., & Nayman, S. (2021) · Current Psychiatry Reports · doi:10.1007/s11920-021-01286-0 · Cited by 93
Dionisie, V., Filip, G. A., Manea, M. C., Movileanu, R. C., Moisa, E., Manea, M., Riga, S., & Ciobanu, A. M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10091924 · Cited by 82
Patterns of pharmacotherapy for bipolar disorder: A GBC survey
Singh, B., Yocum, A. K., Strawbridge, R., Burdick, K. E., Millett, C. E., Peters, A. T., Sperry, S. H., Fico, G., Vieta, E., Verdolini, N., et al. (2023) · Bipolar Disorders · doi:10.1111/bdi.13366 · Cited by 82
Metadata
- Authors
- Gitlin, M. J.
- Affiliations
- University of California, Los Angeles (US)
- Corresponding author
- Gitlin, Michael J.
- ORCID
- Gitlin, Michael J.
- Venue
- International Journal of Bipolar Disorders
- Published
- 2018-12
- Volume
- 6
- Issue
- 1
- Pages
- 25-25
- ISSN
- 2194-7511 (ISSN-L)
- PMC
- PMC6269438
- OpenAlex
- W2895700889
- Cited by
- 116
- References
- 63
- Citations by year
- 2026: 14 · 2025: 24 · 2024: 15 · 2023: 16 · 2022: 15 · 2021: 13 · 2020: 11 · 2019: 8
- FWCI
- 1.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Bipolar Disorders (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- International Society for Bipolar Disorders
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- antidepressants, bipolar depression, bipolar disorder, tricyclic antidepressants, selective serotonin reuptake inhibitors, bipolar II depression, bipolar I disorder, mixed features, rapid cycling, stimulant abuse, antidepressant monotherapy, mood stabilizers, maintenance therapy
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