Antidepressants ‘ineffective’ for bipolar depression
MedWire News: Antidepressant medications are no more effective than placebo or other standard treatments for bipolar depression, results from a systematic review and meta-analysis show.
"The role of antidepressants in the acute treatment of bipolar depression remains a contentious issue," comment Michelle Sidor (University of Texas, Dallas, USA) and colleagues in the Journal of Clinical Psychiatry.
The researchers explain: "A previous meta-analysis of randomized controlled trials (RCTs) concluded that antidepressants were effective and safe for bipolar depression."
But they add: "Several trials published since then suggest that antidepressants may not be as beneficial as previously concluded."
To investigate further, the team searched the literature for RCTs published between 2004 and 2009 that compared acute (<16 weeks) treatment with an antidepressant medication versus either another standard drug or placebo, in adult bipolar disorder patients who were experiencing an episode of depression.
In total, six RCTs involving 1034 depressed bipolar disorder patients were identified. The results from these studies were then combined with those from nine earlier RCTs published between 1980 and 2003, involving 1339 depressed bipolar disorder patients.
Analysis of the pooled results revealed no significant benefit of antidepressant treatment versus placebo or other standard treatments regarding clinical response, defined as a 50% or greater reduction in scores on the Hamilton Depression Rating Scale (HDRS) or the Montgomery-Åsberg Depression Rating Scale (MADRS).
Treatment with antidepressants was also no better than placebo or other standard treatments for the induction of clinical remission, defined as a HDRS end score of seven or less, with or without a Clinical Global Impression score of two or less, a MADRS score of 12 or less, or 1-7 weeks of euthymia.
Overall, antidepressant treatment was not associated with an increased risk for affective switch to hypomanic or manic symptoms compared with placebo or other standard treatments.
Sidor and team conclude: "Although antidepressants were found to be safe for the acute treatment of bipolar depression, their lack of efficacy may limit their clinical utility."
However, they add: "Further studies are required to determine whether there is a role for antidepressant medication in the treatment of some subgroups of patients with bipolar disorder such as those with bipolar II disorder or those with a minimal history of switch into mania or hypomania."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Mark Cowen