Study: Antidepressants Not Effective for Bipolarity
Antidepressants, which commonly are prescribed as an off-label treatment in addition to mood stabilizers for patients with bipolar disorder, are ineffective in relieving the depressive or manic symptoms associated with the illness, according to a study in the New England Journal of Medicine, the Los Angeles Times reports.
Standard treatment for bipolar disorder consists of mood stabilizers such as lithium, valproate and carbamazepine. Patients often are prescribed antidepressants to control severe depressive mood swings, despite concerns that they could trigger a manic episode and that they are not an FDA-approved treatment for the disorder. About 50% to 70% of bipolar patients are prescribed antidepressants, according to estimates.
For the study, lead author Gary Sachs, director of the bipolar clinic at Massachusetts General Hospital, and colleagues studied 366 patients at 22 academic centers across the U.S. who were assigned to take Wellbutrin, Paxil or a placebo in addition to their mood stabilizers for 26 weeks. Wellbutrin and Paxil were selected for the study because earlier research suggested that they are less likely to trigger a manic episode.
Of the 179 participants who received one of the antidepressants, 23.5% had a "durable recovery," which was defined as an eight-week period with no more than two depressive or two manic symptoms, according to the Times. In the placebo group, 27.3% achieved durable recovery, a difference that was not statistically significant.
Researchers said that 10.1% of participants in the antidepressant group exhibited manic symptoms, compared with 10.7% of those in the placebo group (Gellene, Los Angeles Times, 3/29).
Sachs said the findings "suggest that there is no reason to give the standard antidepressants as the standard treatment." The Wall Street Journal reports that the findings "could help curb use of antidepressants, but even advocates of less use said they didn't expect any near-term falloff" (Tomsho, Wall Street Journal, 3/29). The study is available online.