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  • The International Journal of Neuropsychopharmacology, Volume 16, Issue 7
  • August 2013, pp. 1673-1685

Overview of antidepressant treatment of bipolar depression

  • Gustavo H. Vázquez (a1) (a2), Leonardo Tondo (a1) (a3) (a4), Juan Undurraga (a1) (a5) and Ross J. Baldessarini (a1) (a3)
  • DOI: http://dx.doi.org/10.1017/S1461145713000023
  • Published online: 22 February 2013
Abstract
Abstract

Bipolar depression remains a major unresolved challenge for psychiatric therapeutics. It is associated with significant disability and mortality and represents the major proportion of the approximately half of follow-up time spent in morbid states despite use of available treatments. Evidence regarding effectiveness of standard treatments, particularly with antidepressants, remains limited and inconsistent. We reviewed available clinical and research literature concerning treatment with antidepressants in bipolar depression and its comparison with unipolar depression. Research evidence concerning efficacy and safety of commonly used antidepressant treatments for acute bipolar depression is very limited. Nevertheless, an updated meta-analysis indicated that overall efficacy was significantly greater with antidepressants than with placebo-treatment and not less than was found in trials for unipolar major depression. Moreover, risks of non-spontaneous mood-switching specifically associated with antidepressant treatment are less than appears to be widely believed. The findings encourage additional efforts to test antidepressants adequately in bipolar depression, and to consider options for depression in types I vs. II bipolar disorder, depression with subsyndromal hypomania and optimal treatment of mixed agitated-dysphoric states – both short- and long-term. Many therapeutic trials considered were small, varied in design, often involved co-treatments, or lacked adequate controls.

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Corresponding author
Address for correspondence: Dr G. Vázquez, Department of Neuroscience, Palermo University, Buenos Aires, Argentina. Tel.: 0054 11 4826 0770Fax: 0054 11 4826 0770Email: gazquez@palermo.edu
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V Agosti , JW Stewart (2007) Efficacy and safety of antidepressant monotherapy in the treatment of bipolar-II depression. Int Clin Psychopharmacol 22:309311.

L Altshuler , T Suppes , D Black , WA Nolen , PE Keck Jr., MA Frye , S McElroy , R Kupka , H Grunze , J Walden , G Leverich , K Denicoff , D Luckenbaugh , R Post (2003) Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at one-year follow-up. Am J Psychiatry 160:12521262.

BH Amit , A Weizman (2012) Antidepressant treatment for acute bipolar depression: an update. Depress Res Treat. Advance online publication. doi:10.1155/2012/684725.

JD Amsterdam , J Shults (2005) Comparison of fluoxetine, olanzapine, and the combination of fluoxetine and olanzapine in initial therapy of bipolar type I and type II major depression: lack of manic induction. J Affect Disord 87:121130.

JD Amsterdam , J Shults (2008) Comparison of short-term venlafaxine versus lithium monotherapy for bipolar II major depressive episode: randomized open-label study. J Clin Psychopharmacol 28:171181.

F Angst , HH Stassen , PJ Clayton , J Angst (2002) Mortality of patients with mood disorders: follow up of 34–38 years. J Affect Disord 68:167181.

J Angst , JM Azorin , C Bowden , G Perugi , E Vieta , A Gamma , AH Young (2011) Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode. Arch Gen Psychiatry 68:791799.

R Baldessarini , H Henk , A Sklar , J Chang , L Leahy (2008) Psychotropic medications for patients with bipolar disorder in the United States: polytherapy and adherence. Psychiatr Serv 59:11751183.

RJ Baldessarini , GL Faedda , J Hennen (2005) Risk of mania with serotonin reuptake inhibitors vs. tricyclic antidepressants in children, adolescents and young adults. Arch Pediatr Adolesc Med 159:298299.

RJ Baldessarini , L Leahy , S Arcona , D Gause , W Zhang , J Hennen (2007a) Patterns of psychotropic drug prescription for US patients with diagnoses of bipolar disorders. Psychiatr Serv 58:8591.

RJ Baldessarini , P Salvatore , H-MK Khalsa , P Gebre-Medhin , H Imaz , A González-Pinto , J Perez , N Cruz , C Maggini , M Tohen (2010a) Morbidity in 303 first-episode bipolar I disorder patients. Bipolar Disord 12:264270.

RJ Baldessarini , P Salvatore , H-MK Khalsa , M Tohen (2010b) Dissimilar morbidity following initial mania versus mixed-states in type-I bipolar disorder. J Affect Disord 126:299302.

RJ Baldessarini , L Tondo , C Ghiani , B Lepri (2010c) Discontinuation rate vs. recurrence risk following long-term antidepressant treatment in major depressive disorder patients. Am J Psychiatry 167:934941.

RJ Baldessarini , J Undurraga , GH Vázquez , L Tondo , P Salvatore , K Ha , H-MK Khalsa , B Lepri , TH Ha , JS Chang , M Tohen , E Vieta (2012) Predominant recurrence polarity among 928 adult international bipolar I disorder patients. Acta Psychiatr Scand 125:293302.

RJ Baldessarini , E Vieta , JR Calabrese , M Tohen , CL Bowden (2010d) Bipolar depression: overview and commentary. Harv Rev Psychiatry 18:143157.

M Bauer , ED London , N Rasgon , SM Berman , MA Frye , LL Altshuler , MA Mandelkern , J Bramen , B Voytek , R Woods , JC Mazziotta , PC Whybrow (2005a) Supraphysiological doses of levothyroxine alter regional cerebral metabolism and improve mood in bipolar depression. Mol Psychiatry 10:456469.

MS Bauer , L Altshuler , DR Evans , T Beresford , WO Williford , R Hauger (2005b) Prevalence and distinct correlates of anxiety, substance, and combined comorbidity in a multi-site public sector sample with bipolar disorder. J Affect Disord 85:301315.

MS Bauer , P Ritter , H Brunze , A Pfennig (2012) Treatment options for acute depression in bipolar disorder. Bipolar Disord 14 (Suppl. 2):3750.

JM Biernacka , SL McElroy , S Crow , A Sharp , J Benitez , M Veldic , S Kung , JM Cunningham , RM Post , D Mrazek , MA Frye (2012) Pharmacogenomics of antidepressant induced mania: review and meta-analysis of the serotonin transporter gene (5HTTLPR) association. J Affect Disord 136:e21e29.

A Bocchetta , F Bernardi , C Burrai , M Pedditzi , M Del Zompo (1993) Double-blind study of L-sulpiride versus amitriptyline in lithium-maintained bipolar depressives. Acta Psychiatr Scand 88:434439.

EB Brown , SL McElroy , PE Keck Jr., A Deldar , DH Adams , M Tohen , DJ Williamson (2006) Seven-week, randomized, double-blind trial of olanzapine/fluoxetine combination versus lamotrigine in the treatment of bipolar I depression. J Clin Psychiatry 67:10251033.

JR Calabrese , RF Huffman , RL White , S Edwards , TR Thompson , JA Ascher , ET Monaghan , RA Leadbetter (2008) Lamotrigine in the acute treatment of bipolar depression: results of five double-blind, placebo-controlled clinical trials. Bipolar Disord 10:323333.

JR Calabrese , TA Ketter , JM Youakim , JM Tiller , R Yang , MA Frye (2010) Adjunctive armodafinil for major depressive episodes associated with bipolar I disorder: randomized, multicenter, double-blind, placebo-controlled, proof-of-concept study. J Clin Psychiatry 71:13631370.

F Centorrino , GA Masters , A Talamo , RJ Baldessarini , D Öngür (2012) Metabolic syndrome in psychiatrically hospitalized patients treated with antipsychotics and other psychotropics. Hum Psychopharmacol 27:521526.

JB Cohn , G Collins , E Ashbrook , JF Wernicke (1989) Combination of fluoxetine, imipramine, and placebo in patients with bipolar depressive disorder. Int Clin Psychopharmacol 4:313322.

R Correa , H Akiskal , W Gilmer , AA Niereneberg , M Trivedi , S Zisook (2010) Is unrecognized bipolar disorder a frequent contributor to apparent treatment resistant depression? J Affect Disord 127:1018.

N Cruz , J Sanchez-Moreno , F Torres , JM Goikolea , M Valenti , E Vieta (2010) Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: meta-analysis. Int J Neuropsychopharmacol 13:514.

J De Fruyt , E Deschepper , K Audenaert , E Constant , M Floris , W Pitchot , P Sienaert , D Souery , S Claes (2012) Second generation antipsychotics in the treatment of bipolar depression: systematic review and meta-analysis. J Psychopharmacol 26:603617.

M De Hert , CU Correll , J Bobes , M Cetkovich-Bakmas , D Cohen , I Asai , J Detraux , S Gautam , H-J Möller , DM Ndetei , JW Newcomer , R Uwakwe , S Leucht (2011) Physical illness in patients with severe mental disorders: prevalence, impact of medications and disparities in health care. World Psychiatry 10:5277.

B Dierckx , WT Heijnen , WW van den Broek , TK Birkenhäger (2012) Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: meta-analysis. Bipolar Disord 14:146150.

KN Fountoulakis (2010) Update of evidence-based treatment of bipolar depression: where do we stand? Curr Opin Psychiatry 23:1924.

KN Fountoulakis , S Kasper , O Andreassen , P Blier , A Okasha , E Severus , M Versiani , R Tandon , H-J Möller , E Vieta (2012) Efficacy of pharmacotherapy in bipolar disorder: report by the WPA section on pharmacopsychiatry. Eur Arch Psychiatry Clin Neurosci 262 (Suppl. 1):148.

MA Frye , H Grunze , T Suppes , SL McElroy , PE Keck Jr., J Walden , GS Leverich , LL Altshuler , S Nakelsky , S Hwang , J Mintz , RM Post (2007) Placebo-controlled evaluation of adjunctive modafinil in the treatment of bipolar depression. Am J Psychiatry 164:12421249.

MA Frye , K Ha , S Kanba , T Kato , SL McElroy , A Özerdem , GH Vázquez , E Vieta (2011) International consensus group on depression prevention in bipolar disorder. J Clin Psychiatry 72:12951310.

MA Frye , G Helleman , SL McElroy , LL Altshuler , DO Black , PE Keck Jr., WA Nolen , R Kupka , GS Leverich , H Grunze , J Mintz , RM Post , T Suppes (2009) Correlates of treatment-emergent mania associated with antidepressant treatment in bipolar depression. Am J Psychiatry 166:164172.

MS George , JJ Taylor , EB Short (2013) The expanding evidence base for rTMS treatment of depression. Curr Opin Psychiatry 26:1318.

SN Ghaemi , DJ Hsu , F Soldani , FK Goodwin (2003) Antidepressants in bipolar disorder: the case for caution. Bipolar Disord 5:421433.

SN Ghaemi , MM Ostacher , RS El-Mallakh , D Borrelli , CF Baldassano , ME Kelley , MM Filkowski , J Hennen , GS Sachs , FK Goodwin , RJ Baldessarini (2010) Antidepressant discontinuation in bipolar depression: systematic treatment enhancement program for bipolar disorder (STEP-BD) randomized clinical trial of long-term effectiveness and safety. J Clin Psychiatry 71:372380.

SN Ghaemi , KJ Rosenquist , JY Ko , CF Baldassano , NJ Kontos , RJ Baldessarini (2004) Antidepressant treatment in bipolar versus unipolar depression. Am J Psychiatry 161:163165.

SN Ghaemi , AP Wingo , MA Filkowski , RJ Baldessarini (2008) Long-term antidepressant treatment in bipolar disorder: meta-analyses of benefits and risks. Acta Psychiatr Scand 118:347356.

HJ Gijsman , JR Geddes , JM Rendell , WA Nolen , GM Goodwin (2004) Antidepressants for bipolar depression: systematic review of randomized, controlled trials. Am J Psychiatry 161:15371547.

JF Goldberg , RH Perlis , SN Ghaemi , JR Calabrese , CL Bowden , S Wisniewski , DJ Miklowitz , GS Sachs , ME Thase (2007) Adjunctive antidepressant use and symptomatic recovery among bipolar depressed patients with concomitant manic symptoms: findings from the STEP-BD. Am J Psychiatry 164:13481355.

GM Goodwin (2009) Evidence-based guidelines for treating bipolar disorder: revised second edition – recommendations from the British Association for Psychopharmacology. J Psychopharmacol (Oxford) 23:346388.

F Grossman , WZ Potter , EA Brown , G Maislin (1999) Double-blind study comparing idazoxan and bupropion in bipolar depressed patients. J Affect Disord 56:237243.

H Grunze , E Vieta , GM Goodwin , C Bowden , RW Licht , H-J Möller , S Kasper (2010) World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update on treatment of acute bipolar depression. World J Biol Psychiatry 11:81109.

O Heeren , M Sanchez de Carmona , GH Vázquez , R Cordoba , J Forero , L Madrid , D Lara , R Medina , L Meza (2011) Psychotropic drug treatment preferences for Latin American bipolar disorder patients. Rev Psiquiatr Salud Ment 4:205211.

RH Howland (2012) Use of dopaminergic and stimulant drugs for the treatment of depression. J Pyschosoc Nurs Ment Health Serv 50:1114.

RT Joffe , GM MacQueen , M Marriott , LT Young (2005) One-year outcome with antidepressant-treatment of bipolar depression. Acta Psychiatr Scand 112:105109.

LL Judd , HS Akiskal , PJ Schettler , J Endicott , J Maser , DA Solomon , AC Leon , JA Rice , MB Keller (2002) Long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 59:530537.

PE Keck Jr., RC Kessler , R Ross (2008) Clinical and economic effects of unrecognized or inadequately treated bipolar disorder. J Psychiatr Pract 14 (Suppl. 2):3138.

PR Keck Jr., J Mintz , SL McElroy , MP Freeman , T Suppes , ME Frye , LL Altshuler , R Kupka , WA Nolen , GS Leverish , KD Denicoff , H Grunze , N Duan , RM Post (2006) Double-blind, randomized, placebo-controlled trials of ethyl-eicosopentanoate in the treatment of bipolar depression and rapid cycling bipolar disorder. Biol Psychiatry 60:10201022.

AM Kilbourne , JR Cornelius , X Han , HA Pincus , M Shad , I Salloum , J Conigliaro , GL Haas (2004) Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disord 6:368373.

KRR Krishnan (2005) Psychiatric and medical comorbidities of bipolar disorder. Psychosom Med 67:18.

DJ Kupfer (2005) Increasing medical burden in bipolar disorder. J Am Med Assoc 293:25282530.

RW Kupka , LL Altshuler , WA Nolen , T Suppes , DA Luckenbaugh , GS Leverich , MA Frye , PE Keck Jr., SL McElroy , H Grunze , RM Post (2007) Three times more days depressed than manic or hypomanic in both bipolar I and bipolar II disorder. Bipolar Disord 9:531535.

M Leboyer , I Soreca , J Scott , M Frye , C Henry , R Tamouza , DJ Kupfer (2012) Can bipolar disorder be viewed as a multi-system inflammatory disease? J Affect Disord 141:110.

GS Leverich , LL Altshuler , MA Frye , T Suppes , SL McElroy , PE Keck Jr., RW Kupka , KD Denicoff , WA Nolen , H Grunze , MI Martinez , RM Post (2006) Risk of switch in mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers. Am J Psychiatry 163:232239.

RW Licht , H Gijsman , WA Nolen , J Angst (2008) Are antidepressants safe in the treatment of bipolar depression? Critical evaluation of their potential risk to induce switch into mania or cycle acceleration. Acta Psychiatr Scand 118:337346.

LS Lorenzo , GH Vázquez , RM Zaratiegui , L Tondo , RJ Baldessarini (2012) Characteristics of bipolar disorder patients given antidepressants. Hum Psychopharmacol 27:486491.

A Martin , C Young , JF Leckman , C Mukonoweshuro , R Rosenheck , D Leslie (2004) Age effects on antidepressant-induced manic conversion. Arch Pediatr Adolesc Med 158:773780.

SL McElroy , RH Weisler , W Chang , B Olausson , B Paulsson , M Brecher , V Agambaram , C Merideth , A Nordenhem , AH Young (2010) Double-blind, placebo-controlled study of quetiapine and paroxetine as monotherapy in adults with bipolar depression (EMBOLDEN II). J Clin Psychiatry 71:163174.

KR Merikangas , HS Akiskal , J Angst , PE Greenberg , RMA Hirschfeld , M Petukhova , RC Kessler (2007) Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry 64:543552.

DJ Muzina , K Gao , DE Kemp , S Khalife , SJ Ganocy , PK Chan , MB Serrano , CM Conroy , JR Calabrese (2011) Acute efficacy of divalproex sodium versus placebo in mood stabilizer-naive bipolar I or II depression: double-blind, randomized, placebo-controlled trial. J Clin Psychiatry 72:813819.

CB Nemeroff , DL Evans , L Gyulai , GS Sachs , CL Bowden , IP Gergel , R Oakes , CD Pitts (2001) Double-blind, placebo-controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. Am J Psychiatry 158:906912.

AMA Nivoli , F Colom , A Murru , I Pacchiarotti , P Castro-Loli , A González-Pinto , KN Fountoulakis , E Vieta (2011) New treatment guidelines for acute bipolar depression: a systematic review. J Affect Disord 129:1426.

WA Nolen , RW Kupka , G Hellemann , MA Frye , LL Altshuler , GS Leverich , T Suppes , PE Keck Jr., S McElroy , H Grunze , J Mintz , RM Post (2007) Tranylcypromine vs. lamotrigine in the treatment of refractory bipolar depression: a failed but clinically useful study. Acta Psychiatr Scand 115:360365.

DM Novick , HA Swartz , E Frank (2010) Suicide attempts in bipolar I and bipolar II disorder: review and meta-analysis of the evidence. Bipolar Disord 12:19.

C O'Donovan , JS Garnham , T Hajek , M Alda (2008) Antidepressant monotherapy in pre-bipolar depression; predictive value and inherent risk. J Affect Disord 107:293298.

U Ösby , L Brandt , N Correia , A Ekbom , P Sparén (2001) Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 58:844850.

I Pacchiarotti , M Valentí , CM Bonnin , AR Rosa , A Murru , GD Kotzalidis , AMA Nivoli , J Sánchez-Moreno , E Vieta , F Colom (2011a) Factors associated with initial treatment response with antidepressants in bipolar disorder. Eur Neuropsychopharmacol 21:362369.

I Pacchiarotti , M Valentí , F Colom , AR Rosa , AMA Nivoli , A Murru , J Sánchez-Moreno , E Vieta (2011b) Differential outcome of bipolar patients receiving antidepressant monotherapy versus combination with an antimanic drug. J Affect Disord 129:321326.

G Parker , H Brotchie (2010) Do the old psychostimulant drugs have a role in managing treatment-resistant depression? Acta Psychiatr Scand 121:308314.

ES Paykel , R Abbott , R Morriss , H Hayhurst , J Scott (2006) Sub-syndromal and syndromal symptoms in the longitudinal course of bipolar disorder. Br J Psychiatry 189:118123.

M Peet (1994) Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants. Br J Psychiatry 164:549550.

RH Perlis , MJ Ostacher , JF Goldberg , DJ Miklowitz , E Friedman , J Calabrese , ME Thase , GS Sachs (2010) Transition to mania during treatment of bipolar depression. Neuropsychopharmacology 35:25452552.

RH Perlis , R Uher , M Ostacher , JF Goldberg , MH Trivedi , AJ Rush , M Fava (2011) Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder. Arch Gen Psychiatry 68:351360.

J Phelps , J Angst , J Katzow , J Sadler (2008) Validity and utility of bipolar spectrum models. Bipolar Disord 10:179193.

SH Poon , K Sim , MY Sum , CN Kuswanto , RJ Baldessarini (2012) Evidence-based options for treatment-resistant adult bipolar disorder patients. Bipolar Disord 14:573584.

RM Post , LL Altshuler , GS Leverich , MA Frye , WA Nolen , RW Kupka , T Suppes , S McElroy , PE Keck , KD Denicoff , H Grunze , J Walden , CM Kitchen , J Mintz (2006) Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. Br J Psychiatry 189:124131.

RM Post , KD Denicoff , GS Leverich , LL Altshuler , MA Frye , TM Suppes , AJ Rush , PE Keck Jr., SL McElroy , DA Luckenbaugh , C Pollio , R Kupka , WA Nolen (2003a) Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. J Clin Psychiatry 64:680690.

RM Post , G Leverich , L Altshuler , M Frye , T Suppes , PE Keck Jr., SL McElroy , W Nolen , R Kupka , H Grunze , J Walden , M Rowe (2011) Differential clinical characteristics, medication usage, and treatment response of bipolar disorder patients in the US versus Netherlands and Germany. Int Clin Psychopharmacol 26:96106.

RM Post , GS Leverich , LL Altshuler , MA Frye , T Suppes , SL McElroy , PE Keck Jr., WA Nolen , M Rowe , RW Kupka , H Grunze , FK Goodwin (2012) Relationship of prior antidepressant exposure to long-term prospective outcome in bipolar I disorder outpatients. J Clin Psychiatry 73:924930.

RM Post , GS Leverich , WA Nolen , RW Kupka , LL Altshuler , MA Frye , T Suppes , S McElroy , P Keck , H Grunze , J Walden (2003b) Re-evaluation of the role of antidepressants in the treatment of bipolar depression: data from the Stanley foundation bipolar network. Bipolar Disord 5:396406.

Z Rihmer , X Gonda (2011) Antidepressant-resistant depression and antidepressant-associated suicidal behavior: role of underlying bipolarity. Depress Res Treat. Advance online publication. doi:10.1155/2011/906462.

SJ Rizvi , M Donovan , P Giacobbe , F Plancenza , S Rotzinger , SH Kennedy (2011) Neurostimulation therapies for treatment resistant depression: focus on vagus nerve stimulation and deep brain stimulation. Int Rev Psychiatry 23:424436.

AR Rosa , CM Bonnín , GH Vázquez , M Reinares , B Solé , R Tabarés-Seisdedos , V Balanzá-Martínez , A González-Pinto , J Sánchez-Moreno , E Vieta (2010) Functional impairment in bipolar II disorder: is it as disabling as bipolar I? J Affect Disord 127:7176.

B Roshanaei-Moghaddam , W Katon (2009) Premature mortality from general medical illnesses among persons with bipolar disorder: review. Psychiatr Serv 60:147156.

JK Rybakowski (2012) Bipolarity and inadequate response to antidepressant drugs: clinical and psychopharmacological perspective. J Affect Disord 136:e13e19.

GS Sachs , AA Nierenberg , JR Calabrese , LB Marangell , SR Wisniewski , L Gyulai , ES Friedman , CL Bowden , MD Fossey , MJ Ostacher , TA Ketter , J Patel , P Hauser , D Rapport , JM Martinez , MH Allen , DJ Miklowitz , MW Otto , EB Dennehy , ME Thase (2007) Effectiveness of adjunctive antidepressant treatment for bipolar depression. New Engl J Med 356:17111722.

A Saricicek , K Maloney , A Muralidharan , B Ruf , HP Blumberg , G Sanacora , B Lorberg , B Pittman , Z Bhagwagar (2011) Levetiracetam in the management of bipolar depression: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 72:744750.

J Sarris , D Mischoulon , I Schweitzer (2011) Adjunctive nutraceuticals with standard pharmacotherapies in bipolar disorder: systematic review of clinical trials. Bipolar Disord 13:454465.

A Schaffer , P Zuker , A Levitt (2006) Randomized, double-blind pilot trial comparing lamotrigine versus citaloporam for the treatment of bipolar depression. J Affect Disord 96:9599.

V Sharma , M Khan , A Smith (2005) Closer look at treatment resistant depression: is it due to a bipolar diathesis? J Affect Disord 84:251257.

RC Shelton , SM Stahl (2004) Risperidone and paroxetine given singly and in combination for bipolar depression. J Clin Psychiatry 65:17151719.

MM Sidor , GM MacQueen (2011) Antidepressants for the acute treatment of bipolar depression: a systematic review and meta-analysis. J Clin Psychiatry 72:156167.

MM Sidor , GM MacQueen (2012) An update on antidepressant use in bipolar depression. Curr Psychiatry Rep 14:696704.

T Silverstone (2001) Moclobemide vs. imipramine in bipolar depression: multicenter double-blind clinical trial. Acta Psychiatr Scand 104:104109.

M Sussman , M Friedman , JR Korn , M Hassan , J Kim , J Menzin (2012) The relationship between use of antidepressants and resource utilization among patients with manic or mixed bipolar disorder episodes: findings from a managed care setting. J Affect Disord 138:425432.

ME Thase , A Jonas , A Khan , CL Bowden , X Wu , RD McQuade , WH Carson , RN Marcus , R Owen (2008) Aripiprazole monotherapy in nonpsychotic bipolar I depression: results of two randomized, placebo-controlled studies. J Clin Psychopharmacol 28:1320.

M Tohen , DP McDonnell , M Case , S Kanba , K Ha , YR Fang , H Katagiri , J-C Gomez (2012) Randomised, double-blind, placebo-controlled study of olanzapine in patients with bipolar I depression. Br J Psychiatry 201:376382.

M Tohen , E Vieta , J Calabrese , TA Ketter , G Sachs , C Bowden , PB Mitchell , F Centorrino , R Risser , RW Baker , AR Evans , K Beymer , S Dube , GD Tollefson , A Breier (2003) Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry 60:10791088.

L Tondo , G Isacsson , RJ Baldessarini (2003) Suicide in bipolar disorder: risk and prevention. CNS Drugs 17:491511.

L Tondo , B Lepri , RJ Baldessarini (2007) Suicidal risks among 2826 Sardinian major depressive disorder patients. Acta Psychiatr Scand 116:419428.

L Tondo , G Vázquez , RJ Baldessarini (2010) Mania associated with antidepressant treatment: comprehensive meta-analytic review. Acta Psychiatr Scand 121:404414.

EF Torrey , JM Davis (2012) Adjunct treatments for schizophrenia and bipolar disorder: what to try when you are out of ideas. Clin Schizophr Relat Psychoses 5:208216.

J Undurraga , RJ Baldessarini (2012) Randomized, placebo-controlled trials of antidepressants for acute major depression: thirty-year meta-analytic review. Neuropsychopharmacology 37:851864.

J Undurraga , RJ Baldessarini , M Valentí , I Pacchiarotti , L Tondo , G Vázquez , E Vieta (2012a) Bipolar depression: clinical correlates of receiving antidepressants. J Affect Disord 139:8993.

J Undurraga , RJ Baldessarini , M Valenti , I Pacchiarotti , E Vieta (2012b) Suicidal risk factors in bipolar I and II disorder patients. J Clin Psychiatry 73:778782.

M Valentí , I Pacchiarotti , CM Bonnín , AR Rosa , D Popovic , AMA Nivoli , JM Goikolea , A Murru , J Undurraga , F Colom , E Vieta (2012) Risk factors for antidepressant-related switch to mania. J Clin Psychiatry 73:e271276.

MLM van der Loos , P Mulder , EGTM Hartong , MBJ Blom , AC Vergouwen , MS van Noorden , MA Timmermans , E Vieta , WA Nolen (2010) Efficacy and safety of two treatment algorithms in bipolar depression consisting of a combination of lithium, lamotrigine or placebo and paroxetine. Acta Psychiatr Scand 122:246254.

MLM van der Loos , PGH Mulder , EGTM Hartong , MBJ Blom , AC Vergouwen , HJUEM de Keyzer , PJH Notten , ML Luteijn , MA Timmermans , E Vieta , WA Nolen (2009) Efficacy and safety of lamotrigine as add-on treatment to lithium in bipolar depression: multicenter, double-blind, placebo-controlled trial. J Clin Psychiatry 70:223231.

RJ van Lieshout , GM MacQueen (2010) Efficacy and acceptability of mood stabilizers in the treatment of acute bipolar depression: systematic review. Br J Psychiatry 196:266273.

E Vieta (2008) Antidepressants in bipolar depression. Acta Psychiatr Scand 118:335336.

E Vieta , A Martinez-Arán , JM Goikolea , C Torrent , F Colom , A Benabarre , M Reinares (2002) A randomized trial comparing paroxetine and venlafaxine in the treatment of bipolar depressed patients taking mood stabilizers. J Clin Psychiatry 63:508512.

PA Vöhringer , SN Ghaemi (2011) Solving the antidepressant efficacy question: effect sizes in major depressive disorder. Clin Ther 33:B49B61.

TA Wehr , FK Goodwin (1979) Rapid cycling in manic-depressives induced by tricyclic antidepressants. Arch Gen Psychiatry 36:555559.

LN Yatham , (2013) Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord. Advance online publication. doi: 10.1111/bdi.12025.

LN Yatham , SH Kennedy , A Schaffer , SV Parikh , S Beaulieu , C O'Donovan , G MacQueen , RS McIntyre , V Sharma , A Ravindran , LT Young , AH Young , M Alda , R Milev , E Vieta , JR Calabrese , M Berk , K Ha , F Kapczinski (2009) Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for bipolar disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder. Bipolar Disord 11:225255.

A Young , RT Joffe , JC Robb , GM MacQueen , M Marriott , I Patelis-Siotis (2000) Double-blind comparison of addition of a second mood stabilizer versus an antidepressant to an initial mood stabilizer for treatment of patients with bipolar depression. Am J Psychiatry 157:124126.

CA Zarate Jr., NE Brutsche , L Ibrahim , J Franco-Chaves , N Diazgranados , A Cravchik , J Selter , CA Marquardt , V Liberty , DA Luckenbaugh (2012) Replication of ketamine's antidepressant efficacy in bipolar depression: randomized controlled add-on trial. Biol Psychiatry 71:939946.

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The The International Journal of Neuropsychopharmacology
  • ISSN: 1461-1457
  • EISSN: 1469-5111
  • URL: /core/journals/the-international-journal-of-neuropsychopharmacology
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