Antidepressants for Bipolar Depression: A Systematic Review of Randomized, Controlled Trials

Harm J. Gijsman, John R. Geddes, Jennifer M. Rendell, Willem A. Nolen, Guy M. Goodwin
2004 American Journal of Psychiatry  
Objective: This study reviewed the evidence from randomized, controlled trials on the efficacy and safety of antidepressants in the short-term treatment of bipolar depression. Method: The authors performed a systematic review and meta-analysis of randomized, controlled trials. They searched the Cochrane Collaboration Depression, Anxiety, and Neurosis Controlled Trials Register, incorporating results of searches of MEDLINE, EMBASE, CINAHL, PsycLIT, PSYNDEX, and LILACS. The main outcome measures
more » ... n outcome measures were the proportion of patients who clinically responded to treatment and the rate of switching to mania. Results: Twelve randomized trials were included, with a total of 1,088 randomly assigned patients. Five trials compared one or more antidepressants with placebo: 75% of these patients were receiving a concurrent mood stabilizer or an atypical antipsychotic. Antidepressants were more effective than placebo. Antidepressants did not induce more switching to mania (the event rate for antidepressants was 3.8% and for placebo, it was 4.7%). Six trials allowed comparison between two antidepressants. The rate of switching for tricyclic antidepressants was 10%, and for all other antidepressants combined, it was 3.2%.
doi:10.1176/appi.ajp.161.9.1537 pmid:15337640 fatcat:dzmoso3y4rhunafklwv3lrwete