Chapter 9. Antidepressant Medications in Bipolar II Disorder

Antidepressant medications have long been viewed with suspicion as a treatment for bipolar disorder (Suppes 2010; Vieta and Garriga 2016). In an International Society for Bipolar Disorders (ISBD) consensus statement from a collaboration of 70 experts in which 173 studies were reviewed, it was concluded that antidepressants had a questionable risk-benefit ratio in the treatment of bipolar disorder patients and should not be used as monotherapy in bipolar I disorder (BD I) patients (Pacchiarotti et al. 2013). Indeed, meta-analyses are inconsistent as to whether antidepressants are efficacious in bipolar depression and whether they induce switch into hypomania and/or mania (hypo/mania) (Gijsman et al. 2004; Liu et al. 2017; McGirr et al. 2016; Vázquez et al. 2013; Zhang et al. 2013). However, the ISBD consensus statement acknowledged that the data for antidepressants in the treatment of bipolar II disorder (BD II) were more mixed than for BD I, and that antidepressant treatment, including as monotherapy, might be appropriate for some BD II patients.