Treatment of Bipolar Depression With Antidepressants Unsupported by Evidence: BJP
The British Journal of Psychiatry has published an important editorial about the use of antidepressants in the case of bipolar depression. The article is written by Dr. Guy M. Goodwin of Oxford University. Dr. Goodwin argues three important things. First, he argues that the treatment of bipolar depression using antidepressants is not supported by the evidence: “Treatment of bipolar disorder with antidepressants tested almost exclusively in unipolar cases is common but unsupported by an appropriate body of evidence.” Second, he argues that the increasing use of antidepressant-resistant depression as a way of finding bipolar disorder provides reason to believe that bipolar depression is resistant to antidepressants. Finally, he makes the practical conclusion that, if a patient is resistant to antidepressants, a physician should suspect bipolar disorder. The abstract of the article can be found here.
Commentary
The editorial is very cautious, and it’s important to note the difference between when a medical author says, “There is no evidence that…does…” and when an author says, “There is evidence that…does not…” Dr. Goodwin notes that large distinction in how bipolar depression is treated in the U.S.A. and Europe, as antidepressants are used far more commonly in Europe. He is calling for a number of studies to examine the relationship between antidepressants and mania in bipolar patients, and comparison of benefits and risks when compared to atypical antipsychotics and mood stabilizers. This, he hopes, will settle many of the questions about the safety and efficacy of antidepressants in bipolar disorder.
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2 Responses to Treatment of Bipolar Depression With Antidepressants Unsupported by Evidence: BJP
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I have a diagnosis (of many years) of BP2 and I am 2 years (so far) in this depressive phase which has been close to suicidal at points. As of last week I have been reducing my dosage of Venlafaxine (slowly, from 300mg which hasn’t worked much but I’m sensitive to hence a careful withdrawal) so that I can try tri-cyclics instead. This is in addition to 800mg Priadel daily (has been as high as 1.2).
This article worries me given my current situation; the Psychiatrist was unwilling to let me try Lamotrigine on top instead
Hi NNNoone,
I’m very sorry to hear that you are having a rough time. Please be safe.
It’s worth noting that Dr. Goodwin is not saying that antidepressants don’t work, just that the current evidence doesn’t show that the benefits outweigh the risks. He’s mainly arguing that more studies need to be done. Your psychiatrist is probably up on the latest literature, and knows your situation. As long as you have a psychiatrist, I suggest following the advice of that psychiatrist, but we are always free to seek advice from other physicians.