Recent pharmacy-based data (Baldessarini et al., 2007) in the USA indicate American clinicians prescribe antidepressant monotherapy as the most common initial treatment for diagnosed bipolar disorder, and with the same frequency in Bipolar II Disorder (BP II) and Bipolar I Disorder (BP I) patients (i.e. in about 50%; only 25% receive mood stabiliser monotherapy). In fact, the whole controversy about using antidepressants in bipolar disorder is rather recent. Despite some early studies in the 1970s and 1980s (Goodwin and Jamison, 1990), the American Psychiatric Association practice guidelines in 1994 still recommended antidepressant plus mood stabiliser as first-line treatment of acute bipolar depression (Hirschfeld et al., 1994). This recommendation did not change until 2002 (Hirschfeld et al., 2002), and even then only applied to non-severe acute bipolar depression. Even this mild change led to a backlash, which continues to this day, particularly in the British Commonwealth (Parker, 2002; Goodwin and Young, 2003) and some parts of Germany (Moller and Grunze, 2000; Moller et al., 2006). Yet it is important to note that this divide, particularly within the English-speaking world, is quite recent – it dates not to 1776 but to 2002. And even still, many bipolar experts in the USA (Altshuler et al., 2003; Keck and McElroy, 2003), and most clinicians (Baldessarini et al., 2007), do not view antidepressant use as problematic. Thus, if antidepressants are in fact ineffective or sometimes harmful (Ghaemi et al., 2003), then we have a major current public health problem that needs to be fixed.