Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression

• Published in: The New England journal of medicine Vol. 356; no. 17; pp. 1711 - 1722
• Main Authors: Sachs, Gary S, Nierenberg, Andrew A, Calabrese, Joseph R, Marangell, Lauren B, Wisniewski, Stephen R, Gyulai, Laszlo, Friedman, Edward S, Bowden, Charles L, Fossey, Mark D, Ostacher, Michael J, Ketter, Terence A, Patel, Jayendra, Hauser, Peter, Rapport, Daniel, Martinez, James M, Allen, Michael H, Miklowitz, David J, Otto, Michael W, Dennehy, Ellen B, Thase, Michael E
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 26.04.2007
• Subjects: Adult; Antidepressants; Antidepressive Agents, Second-Generation - adverse effects; Antidepressive Agents, Second-Generation - therapeutic use; Antimanic Agents - adverse effects; Antimanic Agents - therapeutic use; Biological and medical sciences; Bipolar disorder; Bipolar Disorder - drug therapy; Bupropion - therapeutic use; Clinical medicine; Double-Blind Method; Drug Therapy, Combination; FDA approval; Female; General aspects; Humans; Male; Medical sciences; Mental depression; Neuropharmacology; Paroxetine - therapeutic use; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Regulatory approval; Studies; Treatment Outcome; Mood disorder; Medicine; Depressions; Efficiency; Psychotropic; Antidepressant agent; Depression
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa064135

The risks and benefits of standard antidepressants for patients with bipolar disorder are not well understood. In this randomized, placebo-controlled trial of patients with bipolar disorder, all of whom received a mood stabilizer, adjunctive treatment with an antidepressant did not reduce the symptoms of bipolar depression or increase the risk of mania. In patients with bipolar disorder, all of whom received a mood stabilizer, adjunctive treatment with an antidepressant did not reduce the symptoms of bipolar depression or increase the risk of mania. Bipolar disorder, the sixth-leading cause of disability worldwide, 1 is a chronic and recurrent psychiatric illness with a lifetime prevalence of just under 4% 2 and annual costs that exceed those of diabetes or recurrent (unipolar) major depressive disorder. 3 Although abnormal mood elevation is the cardinal diagnostic feature that distinguishes bipolar disorder from recurrent major depressive disorder, depression that alternates with manic episodes (bipolar depression) is the leading cause of impairment and death among patients with bipolar disorders. 4 – 6 Two main limitations related to standard antidepressant medications hamper their use in the treatment of bipolar depression. First, though these agents have proved . . .