Adjunctive paroxetine or bupropion in the treatment of depression associated with bipolar disorder offers no benefit over mood stabilizers alone but does not induce mania, according to a study published online by the New England Journal of Medicine.
Researchers randomized some 370 bipolar patients experiencing depressive episodes to up to 26 weeks of treatment with a mood stabilizer plus one of the two antidepressants or placebo. Rates of durable recovery (defined as at least 8 weeks of euthymia) were the same in the antidepressant (24%) and placebo (27%) groups, as were rates of cycling to mania (10% and 11%, respectively).
Journal Watch Psychiatry Editor-in-Chief Dr. Peter Roy-Byrne writes that the mania finding is reassuring, since "clinicians concerned about suicidality will continue to prescribe antidepressants for seriously depressed bipolar patients." An editorialist cautions that antidepressants may cause mania in the absence of mood stabilizers and that clinicians should check for a history of mania before initiating antidepressant treatment.
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