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Antidepressants are not an effective adjunct to mood stabilisers for bipolar depression

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Are antidepressants an effective adjunctive treatment to mood stabilisers in the treatment of bipolar depression?

Sachs GS, Nierenberg AA, Calabrese JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med 2007;356:1711–22.


Embedded ImageDesign:

Randomised controlled trial.

Embedded ImageAllocation:


Embedded ImageBlinding:

Double blinded.

Embedded ImageFollow-up period:

Sixteen weeks (treatment period only).

Embedded ImageSetting:

Part of STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder) trials, carried out in 22 centres in the USA; November 1999 to July 2005.

Embedded ImagePatients:

366 adults (aged over 18 years) currently experiencing a DSM-IV major depressive episode associated with bipolar I or bipolar II disorder. Exclusions: history of intolerance or non-response to paroxetine and bupropion; receiving treatment for substance abuse disorder; or requiring addition of, or dose change of, antipsychotic medication.

Embedded ImageIntervention:

Paroxetine (10 mg increased up to maximum 40 mg daily), sustained-release bupropion …

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  • Source of funding: National Institute of Mental Health (NIMH). Antidepressants donated by Glaxo Wellcome and GlaxoSmithKline.


  • Competing interests: None.