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Special Considerations in Bipolar Depression

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The decision to recommend administration or avoidance of antidepressants often means attempting to walk a therapeutic razor's edge between alleviating depression and triggering mood switching. Thus, recent data regarding the protective effect of mood stabilizers against antidepressant-associated switching and the incidence of switching among antidepressants are important to weigh in these decisions. Until recently, most treatment guidelines recommended avoiding antidepressants and relying on mood stabilizers alone in mild to moderate bipolar depression, and when administering antidepressants for severe or persistent bipolar depression, they recommended withdrawing them as quickly as possible after remission (Ghaemi et al. 2001; Sachs et al. 2000). These recommendations were based on reported antidepressant-associated switch rates, which ranged widely, from 10% to 70% (Thase and Sachs 2000).

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