ReviewInternational journal of bipolar disorders2018
Antidepressants in bipolar depression: an enduring controversy.
Review in International journal of bipolar disorders, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
53 citing papers in PubMed, 3 syntheses or guidelines pooled it, 109 citations in OpenAlex.
- Systematic Review of Second-Generation Antidepressant Monotherapy for Acute Bipolar-II Depression.Psychopharmacology bulletin · 2025Pooled it
- Pharmaco-psychiatry and gut microbiome: a systematic review of effects of psychotropic drugs for bipolar disorder.Microbiology (Reading, England) · 2025Pooled it
- Hypnotic and Melatonin/Melatonin-Receptor Agonist Treatment in Bipolar Disorder: A Systematic Review and Meta-Analysis.CNS drugs · 2022Pooled it
- Prescription Trends for Bipolar Disorder With and Without Comorbid Substance Use and Anxiety Disorders: A Global Bipolar Cohort Collaborative Study.Bipolar disorders · 2026Article
- Depression in Opioid Use Disorder: A Tripartite Psychopathological Model for Dual Disorders.Journal of clinical medicine · 2026Article
- Article
- SSRI versus SNRI initiation and incident bipolar disorder in tertiary psychiatric care: an active-comparator cohort study from the United Arab Emirates.International journal of bipolar disorders · 2026Article
- Article
- Differentiating Between Major Depressive Disorder and Bipolar Disorder.Advances in experimental medicine and biology · 2026Review
- Hallucinations during bipolar depressive episode treated with bupropion after alcohol withdrawal surgery: a case report.Frontiers in psychiatry · 2026Article
- Reconceptualizing bipolar disorder through an integrative biological lens: synthesis, convergence, and emerging directions.Frontiers in integrative neuroscience · 2026Review
- Clinical practice guidelines for the management of bipolar disorder: 2025 update.Indian journal of psychiatry · 2026Article
- Antidepressant treatment and risk of subsequent bipolar disorder in adolescents with unipolar depression.BMJ mental health · 2025Article
- Addressing the unmet needs of bipolar disorder in Australia and beyond.The Australian and New Zealand journal of psychiatry · 2025Article
- Artificial Intelligence and Bipolar Disorder: Applications of Machine Learning Models for Diagnosis, Treatment, and Outcome Prediction.Alpha psychiatry · 2025Article
- Global Trends in the Use of Pharmacotherapy for the Treatment of Bipolar Disorder.Current psychiatry reports · 2025Review
- Antidepressants in Bipolar Depression: From Neurotransmitter Mechanisms to Clinical Challenges.Actas espanolas de psiquiatria · 2025Review
- Perspectives on Precision Psychiatry Using Antipsychotics in the Management of Bipolar Disorder.Brain sciences · 2025Review
- Advancements in Valproate Therapy for Seizures, Migraines, and Bipolar Disorders.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2025Review
- Risk of Switch to Mania/Hypomania in Bipolar Depressive Patients Treated with Antidepressants: A Real-World Study.Health data science · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.