This report examined the risk of antidepressant-induced manic switch in patients with bipolar disorder treated either with antidepressant monotherapy or with an antidepressant in conjunction with a mood stabilizer.
Using Swedish national registries, the authors identified 3,240 patients with bipolar disorder who started treatment with an antidepressant and had no antidepressant treatment during the previous year. Patients were categorized into those receiving antidepressant monotherapy and those receiving an antidepressant plus a mood stabilizer.
The increased risk of treatment-emergent mania was confined to patients on antidepressant monotherapy. Among patients treated with a concurrent mood stabilizer, no acute change in risk of mania was observed during the 3 months after the start of antidepressant treatment, and a decreased risk was observed during the period 3-9 months after treatment initiation. The results highlight the importance of avoiding antidepressant monotherapy in the treatment of bipolar disorder.
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Viktorin A, Lichtenstein P, Thase ME, Larsson H, Lundholm C, Magnusson PK, Landén M: The risk of switch to mania in patients with bipolar disorder during treatment with an antidepressant alone and in combination with a mood stabilizer. American J. Psychiatry 171(10):1067-1073 (2014).
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http://www.ncbi.nlm.nih.gov/pubmed/24935197

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