Article Text

Download PDFPDF

Antidepressants in bipolar depression: yes, no, maybe?
  1. Gin S Malhi1,2,3
  1. 1Academic Department of Psychiatry, Kolling Institute, St Leonards, New South Wales, Australia;
  2. 2Sydney Medical School–Northern, The University of Sydney, St Leonards, New South Wales, Australia;
  3. 3Department of Psychiatry, CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
  1. Correspondence to Professor Gin S Malhi, CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, Level 3, Main Hospital Building, St Leonards, NSW 2065, Australia; gin.malhi{at}


Antidepressants are widely used in the treatment of bipolar depression despite relatively meagre evidence for their efficacy and significant concerns that their prescription can precipitate an acute affective switch into mania/hypomania and that long-term administration can lead to mood instability. Therefore, the use of antidepressants to treat bipolar depression is an important but contentious issue that two recent studies, which provide important new evidence, attempt to inform. One study suggests that long-term continuation of antidepressants in patients with rapid-cycling bipolar disorder leads to a threefold increase in mood episodes during the first year of follow-up—supporting the notion that antidepressants can cause more harm than good, and that they should be used sparingly. However, this is countered by findings from the other study, which suggests that continuation antidepressant monotherapy provides patients with bipolar II disorder reasonable prophylaxis, and that the risk of switching into mania/hypomania is actually quite low. In addition to contrary findings both studies are modest in sample sizes and have significant design limitations and hence the debate remains unresolved. This brief perspective presents both views in the context of evidence and provides some key insights into the complexity of this challenging but common clinical issue.

View Full Text

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.