David Baxter PhD
Late Founder
No switching or rapid cycling with antidepressants in bipolar disorder
By Liam Davenport
17 October 2008
Acta Psychiatr Scand 2008; 118: 337?346
Antidepressants, when used alongside a mood stabilizer, do not appear to induce a switch to hypomania or mania in patients with acute bipolar depression, European study findings indicate.
It has been suggested that use of antidepressants in bipolar disorder patients may induce hypomania/mania and rapid cycling, leading to some guidelines warning against their usage. However, the evidence is not conclusive.
To examine whether antidepressants increase the risk for a switch from depression to hypomania or mania, or cycle acceleration in bipolar disorder patients, Rasmus Licht, from Aarhus University Hospital in Denmark, and colleagues conducted a literature review.
The team searched the MEDLINE database, major meta-analyses, reviews, and observational studies, identifying randomized controlled trials of antidepressants in bipolar disorder. They applied the Bedford?Hill criteria, which focuses on the specificity of the agent, strength of effect, consistency of findings, dose-response relation, temporal associations between exposure and effect, and biological plausibility.
Writing in the journal Acta Psychiatrica Scandinavica, the researchers say that there is a lack of randomized controlled trials, and that all of the available studies contain various forms of bias.
They note that the data supporting the efficacy of antidepressants in bipolar depression are conflicting, and that there is no clear consensus on the definition of a switch to hypomania or mania.
However, they say that there is sufficient evidence to assert that switching is a natural phenomenon, and that rates of switching did not change after the introduction of antidepressants.
Short-term studies into switching during antidepressant treatment, combined with mood stabilizers, all suffer from selection bias and are inconclusive, the team says, and the results do not support the notion that antidepressants induce switching. It is also not possible, from the available evidence, to state that one antidepressant is significantly more likely to cause switching than another.
The researchers also write that there is a lack of systematic data on the proposed link between antidepressants and accelerated episode frequency in bipolar disorder patients, but the available information suggests that there is no association.
?Taken together, the belief that antidepressants (even in combination with mood stabilizers) induce switches and/or rapid cycling is not sufficiently justified by evidence,? the team says. ?This belief may create unnecessary anxiety not only among clinicians but also among patients and their relatives.?
Abstract
By Liam Davenport
17 October 2008
Acta Psychiatr Scand 2008; 118: 337?346
Antidepressants, when used alongside a mood stabilizer, do not appear to induce a switch to hypomania or mania in patients with acute bipolar depression, European study findings indicate.
It has been suggested that use of antidepressants in bipolar disorder patients may induce hypomania/mania and rapid cycling, leading to some guidelines warning against their usage. However, the evidence is not conclusive.
To examine whether antidepressants increase the risk for a switch from depression to hypomania or mania, or cycle acceleration in bipolar disorder patients, Rasmus Licht, from Aarhus University Hospital in Denmark, and colleagues conducted a literature review.
The team searched the MEDLINE database, major meta-analyses, reviews, and observational studies, identifying randomized controlled trials of antidepressants in bipolar disorder. They applied the Bedford?Hill criteria, which focuses on the specificity of the agent, strength of effect, consistency of findings, dose-response relation, temporal associations between exposure and effect, and biological plausibility.
Writing in the journal Acta Psychiatrica Scandinavica, the researchers say that there is a lack of randomized controlled trials, and that all of the available studies contain various forms of bias.
They note that the data supporting the efficacy of antidepressants in bipolar depression are conflicting, and that there is no clear consensus on the definition of a switch to hypomania or mania.
However, they say that there is sufficient evidence to assert that switching is a natural phenomenon, and that rates of switching did not change after the introduction of antidepressants.
Short-term studies into switching during antidepressant treatment, combined with mood stabilizers, all suffer from selection bias and are inconclusive, the team says, and the results do not support the notion that antidepressants induce switching. It is also not possible, from the available evidence, to state that one antidepressant is significantly more likely to cause switching than another.
The researchers also write that there is a lack of systematic data on the proposed link between antidepressants and accelerated episode frequency in bipolar disorder patients, but the available information suggests that there is no association.
?Taken together, the belief that antidepressants (even in combination with mood stabilizers) induce switches and/or rapid cycling is not sufficiently justified by evidence,? the team says. ?This belief may create unnecessary anxiety not only among clinicians but also among patients and their relatives.?
Abstract
