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

date, adding articles as they appear, on both sides of the discussion.   Last update Jan
2002.  

Use caution

Ghaemi N (Director, Bipolar Disorders Research Program; ass't professor, Harvard):
See a series of essays by Dr. Ghaemi on this subject, all of which echo my own main themes
on this website:  

Is Bipolar Disorder Misdiagnosed?
Antidepressants and Bipolar Depression: First, Do No Harm
Antidepressants in Bipolar Disorder: Are They Safe? Are They Effective?
The Bipolar Spectrum: A Valid Forme Fruste?
Mixed states: Broad or Narrow?

Ghaemi SN, Lenox MS, Baldessarini RJ.  Effectiveness and safety of long-term
antidepressant treatment in bipolar disorder.  J Clin Psychiatry 2001 Jul;62(7):565-569
(their review of 7 dbl-blind studies: conclusion -- increased caution warranted but too
little data overall).  

Antidepressant-associated mania or psychosis: 10% of all psychiatric admissions in one
study

Dr. Gary Sachs at Harvard: a case illustration

Dr. Peter Brigham's site
Use the table of contents offered, scroll down to "special cases" at the bottom
    Read "rapid cycling" and "bipolar depression"

Dr. Ron Pies' experience and advice  (a regular columnist for Psychiatric Times)

For an extreme view, see the opinions of Dr. Glenmullen from Harvard
    - His view: Use Prozac and other SRI's with great caution even in unipolar depression
    - See his book, Prozac Backlash
        (full of inflammatory phrases, designed to frighten people)
        (but if the language was more careful, his points might be seen as worth
considering)
        (and the chapter on suicidality induced by Prozac is calmer, well referenced)
    - See an opposing view from the National Mental Health Association (NMHA)

Antidepressant "poop-out" associated with severe, treatment resistant illness:
"METHOD: I describe 15 cases who had a loss of response to repeated trials of
antidepressants before developing a chronic and severe, refractory depression. RESULTS:
...Following discontinuation of antidepressants and treatment with mood stabilizers, there
was a sustained improvement."  J Affect Disord 2001 Apr;64(1):99-106.

Less caution necessary

Finally (Sept. 2001) some direct data, albeit a retrospective chart review: Dr. Altshuler
et al at UCLA compared relapse into depression for those who stayed on an AD (with mood
stabilizer) vs. those who stopped.  Result suggests staying on is actually better, and
precipitating mania was not seen (mostly Bipolar I).  

Recent Bipolar Network News summary (lead article)
See their analysis of why we see differing observations of antidepressant risk

Young et al
Adding a antidepressant to a mood stabilizer (versus adding another mood stabilizer)

Amsterdam et al
This is so radically different from my clinical experience, I am at a loss to understand
their findings.

Moller et al
The European view is also less cautious.

--

Walter E. Afield, M.D. testifying before the Select Committee on Children, Youth, and Families, House of Representative, April 28, 1992

" The DSM-III, were talking about everyone in this room will fit into two or three of the diagnosesIn DSM-II, {*filter*}ity was a disease. In III, its not. In IV, therell be some new diseases. Every new disease thats defined gets a new hospital program, new admissions, a new system and a way to bilk it, and this bilking continues"



Fri, 12 Nov 2004 13:00:55 GMT
 
 [ 1 post ] 

 Relevant Pages 

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

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

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

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


 
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