Mark Frye, Chairman of the Department of Psychiatry at the Mayo Clinic, gave a lecture on antidepressants in bipolar illness at the 2014 meeting of the American Psychiatric Association.
The newest data from meta-analyses indicate that traditional antidepressants that are effective in unipolar depression are not effective in bipolar depression.
Some patient groups, especially those with very early onset depression and mixed depression, are at increased risk of switching into mania and making a suicide attempt while taking antidepressants.
This is the new conventional wisdom on antidepressants in bipolar disorder. It used to be felt that they were almost always harmful, but more recent studies find that the incidence of mood destabilization (more rapid or more severe mood cycling) in bipolar patients treated with antidepressants is less than had been thought.
It remains true that some patients (particularly some patients with bipolar disorder type 2) appear to benefit from the SSRI’s, especially for certain symptoms of anxiety, which are very common in patients with bipolar 2.