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Review: long term use of antidepressants for bipolar disorder reduces depressive episodes but increases risk of mania

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What is the effectiveness of long term antidepressants in people with bipolar disorder?


New episodes of depression or mania (DSM III, DSM IV, ICD 9, ICD 10 or Research Diagnostic Criteria (RDC)).



Systematic review with meta-analysis.

Data sources:

MEDLINE, EMBASE, PsycINFO, HealthStar, Current Contents, CINAHL, National Library of Medicine, DARE and Cochrane Library databases were searched from inception to May 2008 for randomised controlled trials (RCTs). Bibliographies of reports identified by computer searching, reviews on treatment of bipolar disorder (BPD) and abstracts or poster presentations from selected meetings were hand searched. Experts and funding agencies were contacted to find data from unpublished trials, and details of trials were verified with the authors where necessary.

Study selection and analysis:

Two reviewers appraised the studies and selected RCTs of long term use of antidepressant treatment in people with BPD. Inclusion criteria: diagnosis of BPD according to DSM-III, DSM IV, ICD 9, ICD 10 or RDC; participants randomised to any antidepressant versus a non-antidepressant or placebo, with or without co-treatment …

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  • Source of funding: NIH, Bruce J Anderson Foundation, McLean Private Donors Neuropsychopharmacology Research Fund.


  • Competing interests: AY was the principal investigator of the Embolden studies (funded by Astra Zeneca) and has received lecture fees and honoraria from various pharmaceutical companies which make products which might be used in bipolar disorder.

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