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Switching, Induction of Rapid Cycling, and Increased Suicidality With Antidepressants in Bipolar Patients: Fact or Overinterpretation?

Published online by Cambridge University Press:  07 November 2014

Heinz C.R. Grunze
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Abstract

Antidepressants constitute a central cornerstone in the treatment of depressive syndromes. In bipolar patients, however, there is an ongoing controversy about their usefulness for at least 3 decades. Early reports, mainly concerning tricyclic antidepressants, have repeatedly pointed toward unfavorable side effects on the course of the disorder, namely switching into (hypo)mania, induction of rapid cycling, and increased risk of suicide. Most evidence for both unfavorable and favorable effects has been deducted, thus far, from small studies with methodological flaws. More substantiated evidence only recently became available. From this it appears that, at least, the switch risk, and perhaps also the risk for rapid cycling and new-onset suicidality have been overinterpreted. At the same time, these new data raise doubt about the efficacy of anti-depressants as a primary-treatment choice in bipolar depression.

Type
Review Articles
Information
CNS Spectrums , Volume 13 , Issue 9 , September 2008 , pp. 790 - 795
Copyright
Copyright © Cambridge University Press 2008

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