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Study: Antidepressants Do Not Help in Bipolar Treatment
> 6/29/2007 10:17:55 AM

Despite a lack of solid consensus on their effectiveness, many psychiatrists prescribe antidepressants to augment the normal mood stabilizer treatment of bipolar disorder. A new double-blind study led by Dr. Gary Sachs suggests that this medication combination does not produce positive effects.

The two most important questions to resolve about antidepressants and bipolar disorder are whether antidepressants aid treatment, and whether they bring negative side-effects like increased mood cycling. Dr. Sachs followed two groups of patients, each with close to 200 members, for 26 weeks to see if there was any difference between the placebo and antidepressant group. The findings are striking. Antidepressants not only showed no positive effect, they actually had slightly lower rates of recovery- 23.5% compared to 27.3%. Fortunately, the study found no evidence of increased cycling.

Previous studies have supported the idea that antidepressants do not accelerate mood changes, but they have differed from Dr. Sachs by finding evidence of effectiveness. For example, a 2004 study in the American Journal of Psychiatry found a beneficial effect comparable to that found with unipolar depression. How can we resolve the discrepancy between these two studies? It is helpful to examine the criterion that Dr. Sachs used for durable recovery- 8 consecutive weeks of neutral mood. The 2004 study followed groups for only 4-10 weeks, not long enough to notice whether stability would be long-term. This is an argument for the Dr. Sachs study being more accurate. On the other hand, Dr. Sachs only examined Wellbutrin and Paxil. By limiting his study to these two drugs, he may have missed a few antidepressants that can be extremely helpful for certain individuals.

While the discrepancies still need more sorting out, we can draw one clear conclusion from the newer study. Not all antidepressants are effective complements to mood stabilizers. Further study must be done to verify Sachs's findings and to determine which, if any, of the antidepressants actually work. While it is a relief to confirm that there are no serious cycling side-effects, it is still poor policy to prescribe superfluous medication because of all the accompanying issues such as cost and potential negative side effects.

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