Antidepressants May Not Help Fight Bipolar Disorder

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Although antidepressants have never been approved to treat bipolar disorder, and although there is limited evidence as to their safety and efficacy, such medications are commonly prescribed in addition to a mood stabilizer.

However, many researchers worry that antidepressants may even trigger a manic episode in bipolar patients.

"This practice is extremely prevalent," Sachs said. "The investigators agreed that the number one priority was resolving this issue, because there are two competing expert recommendations: a stabilizer plus an antidepressant or a stabilizer alone. We asked the question, 'Would two be better than one?' "

This trial, a collaboration with the U.S. National Institutes of Mental Health, randomly assigned 336 individuals with bipolar disorder from "real world," clinical settings to take a mood stabilizer plus either an antidepressant (bupropion/Wellbutrin or paroxetine/Paxil) or a placebo.

After about 26 weeks, 23.5 percent of patients taking antidepressants had stayed well for at least eight weeks in a row vs. 27.3 percent of those taking a placebo. The difference was not statistically significant.

"In this study, we do not show a benefit nor a problem due to antidepressants," Sachs said. "We didn't show anything to gain. We also didn't show any harm, and there may well be individual patients who might respond to antidepressants and individual antidepressants that actually work better."

Also, about 10 percent of each group -- with or without antidepressants -- experienced the onset of mania.

Sachs was surprised by the finding. "I had firmly believed that antidepressants triggered mania," he said. "This is an important finding of the study. That's a real thing I have to take to heart."

Another expert said the study could change doctors' thinking.

"Treatment needs to be individualized, but, for the vast majority of patients, antidepressants don't offer critical benefit and may carry significant risk," said Dr. Richard Weisler, adjunct professor of psychiatry at the University of North Carolina at Chapel Hill and adjunct associate professor of psychiatry at Duke University Medical Center in Durham, N.C.