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When there’s very little evidence to consider, it’s easy for controversies to persist.
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Bottom line: there are at least 9 alternatives with at least as much evidence as antidepressants for effectiveness in bipolar depression, that don’t make bipolar disorder worse, as is clearly a risk with antidepressants. Thus there are loud voices on both sides of this issue. Quoting from an editorial in the American Journal of Psychiatry, March 2008, by Nassir Ghaemi, one of the principal investators in the STEP-BD, a large bipolar research trial (emphases mine): Mood destabilization with antidepressants should be distinguished from an acute manic “switch.” Antidepressant-induced mania, or switch, is a short-term phenomenon; one mht define it as happening within 2 months of the beginning of antidepressant treatment. Antidepressants may cause long-term mood destabilization without a short-term manic switch, and vice versa.
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So most of these questions are nearly moot, in my opinion. But in 2013 the International Society for Bipolar Disorders (ISBD) issued a very clear set of recommendations. Yet it doesn’t really make much difference, you see: yes, there is snificant risk, at least 1 per 25 users, maybe more like 1 per 3 or even 1 per 2 for some people. Although some agents may have low rates of acute manic switch, especially when used with mood stabilizers, the data from STEP-BD suggest that. Ghaemi also emphasizes an approach I’ve been espousing for years: if a mood stabilizer is tried with an antidepressant also in use at the same time, and the mood stabilizer “doesn’t work”, that was an unfair trial of the mood stabilizer.Method scans is effexor for bipolar example, the
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