Do Antidepressants Really Help Treat Bipolar Depression?

(March 28, 2007) -- Antidepressants frequently prescribed to help treat bipolar depression do little to help patients recover, according to a new study that adds fuel to a long-running debate over how to best treat an affliction that affects an estimated eight million Americans.

Bipolar disorder, also known as manic depression, is a serious mental illness that involves dramatic swings in mood, including frequent and lengthy periods of depression. Along with mood-stabilizing drugs like lithium, many physicians also treat the disorder with common antidepressants like bupropion, originally branded as Wellbutrin, and paroxetine, better known as Paxil, although such drugs aren't formally approved for this use.

The study could help curb use of antidepressants, but even advocates of less use said they didn't expect any near-term falloff because patients demand the drugs and primary-care doctors often don't know when they are dealing with the condition or other mental illness.

The study, one of the largest of its kind, looked at 366 bipolar-disorder patients who received 26 weeks of treatment in 22 locales. About half the patients got one of several long-established, mood-stabilizing drugs along with either bupropion or paroxetine. The rest received a mood stabilizer and a placebo.

The study, sponsored by the National Institute of Mental Health and published in this week's New England Journal of Medicine, found no statistically significant differences in results between the two groups although, by some measures, the placebo group faired modestly better. About 27.3% of placebo patients had "durable recoveries," or eight consecutive weeks with a normal, reasonably positive mood. Among those taking antidepressants, only 23.5% had durable recoveries.

Some clinicians have long maintained that antidepressants can trigger outbreaks of mania, or extremely elevated mood, in patients with bipolar disorder although research in that area has been sketchy. The study showed little related difference between the two groups in terms of such episodes.

"I think our findings suggest that there is no reason to give the standard antidepressants as the standard treatment," said Gary Sachs, lead researcher and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital in Boston .

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Other researchers not involved said they don't expect the study to immediately prompt doctors and psychiatrists to stop prescribing antidepressants to their bipolar patients. "I think it's going to take more time," said S. Nassir Ghaemi, director of the Bipolar Disorder Research Program at Emory University , in Atlanta , whose own research indicates that about 80% of all bipolar patients receive antidepressants.

Source: WSJ

Last updated: 03/07

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