PsychEducation.org (home) Antidepressants in Bipolar Disorder: The Controversy (1/2) 
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 PsychEducation.org (home) Antidepressants in Bipolar Disorder: The Controversy (1/2)

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Antidepressants in Bipolar Disorder: The Controversy

There is strong consensus that antidepressants carry risk if used alone near the Bipolar
end of the spectrum below:

The controversy revolves around whether one can safely use antidepressants alone nearer
the "unipolar" end of this spectrum:

Is the "transition point" -- the point at which antidepressants begin to carry some risk
of inducing hypomania -- better indicated by the yellow, or the green arrow below?  

This is the heart of the controversy about using antidepressants in patients within the
bipolar spectrum: where is the arrow?  However, obviously we have no criteria for
"mapping" a patient's position on this spectrum, even if we did know whether the yellow or
the green arrow was more accurate.  Still, almost all psychiatrists agree on the
principle: watch out, if your patient is to the right of the arrow.  We just disagree on
where the arrow is!

Thus even mood experts disagree about how much caution to use when considering
antidepressants for a patient with mild, or subtle, or vague hypomanic signs such as:

severe insomnia (as opposed to decreased need for sleep, a more accepted sign)

moderate irritability (as opposed to profound, irrational, impulsive acts of anger)

anxiety or agitation (possibly the most important risk factor for suicide in mixed
depressed states)

a patient who endorses "racing thoughts", but does not volunteer this complaint

For patients like this with depression, choosing an antidepressant alone is still a more
common choice than choosing a mood stabilizer.  I think that will change, but for now, you
can use either medication with lots of good company.

IN SUM:  

1. Do not use antidepressants if hypomania is already clearly present.

2. If a patient becomes hypomanic when given an antidepressant, strongly consider a mood
stabilizer (see guidelines on their use in primary care) as opposed to another
antidepressant.

3. If in doubt, refer for a diagnostic consultation (if no psychiatrist is available, use
a therapist whose diagnostic skills you trust) before proceeding.  At minimum, use the
1-page screening tool to "rule out bipolar", and/or have the patient read about bipolar II
to enlist her/his efforts re: accurate diagnosis and understanding of risk.

Here are some more links on this controversy if you wish.  I will try to keep this up to



Fri, 12 Nov 2004 13:00:54 GMT
 
 [ 1 post ] 

 Relevant Pages 

1. PsychEducation.org (home) Antidepressants in Bipolar Disorder: The Controversy (2/2)

2. PsychEducation.org (home) Antidepressants in Bipolar Disorder: The Controversy (1/2)

3. PsychEducation.org (home) Antidepressants in Bipolar Disorder: The Controversy (2/2)

4. Present News About bipolar disorder. bipolar ii disorder,bipolar disorder stories,bipolar disorder diagnosis,i think i have bipolar disorder,bipolar disorder 2

5. Antidepressants as a Treatment for Bipolar Disorder avoid antidepressants of any kind if possible

6. really phobic about antidepressants generally, in bipolar disorder

7. evidence that antidepressants can possess long-term risks in the treatment of bipolar disorder

8. antidepressants often are overused in the treatment of bipolar disorder (1/2)

9. antidepressants often are overused in the treatment of bipolar disorder (2/2)

10. First, we know for sure that antidepressants can make bipolar disorder worse

11. evidence that antidepressants can possess long-term risks in the treatment of bipolar disorder

12. antidepressants often are overused in the treatment of bipolar disorder (1/2)


 
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