Presented at the American Psychiatric Association 2004 Annual Meeting

The appropriate administration of antidepressants in patients with bipolar disorder is a challenging clinical problem. Antidepressants can, even in the presence of the administration of an adequate dose of a mood stabilizer, induce mania and cycling. Since there are now several clinical alternatives to antidepressant use in patients with cycling mood, these questions are of great clinical relevance in this difficult-to-treat population. Three studies were presented at the American Psychiatric Association 2004 Annual Meeting that attempted to address these questions.

The current studies were part of a large STEP-BD (Systemic Treatment Enhancement Program for Bipolar Disorder) study being conducted at numerous study sites nationally.[1] In a study by Pardo and colleagues,[2] 33 patients who had responded to a mood stabilizer and adjunctive antidepressant were included. Subjects were openly randomized to either discontinue the antidepressant (short-term [ST] group) or continue on the medication (long-term [LT] group). Patients were rated using the Life Chart Methodology as well as the Clinical Monitoring Form, and they were followed for a period of 1 year. The antidepressants utilized included selective serotonin reuptake inhibitors (64%), bupropion (Wellbutrin XL) (21%), venlafaxine (Effexor) (7%), and methylphenidate (Ritalin) (7%). The mood stabilizers included lithium (Eskalith) (55%), divalproex (Depakote) (12%), lamotrigine (24%), and others (70%).

The findings were as follows:

1. Subjects were rated as euthymic 58.6% of the time, depressed 30.3% of the time, and manic 4.88% of the time.
2. The time in remission was similar in the ST group (74.2%) compared with the LT group (67.3%). Remission was defined as