NEW YORK (Reuters Health) - The swings in mood from depression to mania that afflict people with bipolar disorder can be tempered with drugs such as lithium, but adding an antidepressant drug to ease the depression component is not helpful, new research suggests.
Depressive episodes are the main cause of disability for people with bipolar disorder, formerly known as manic depression, according to the report in The New England Journal of Medicine. However, few studies have assessed the benefits of standard antidepressant drugs in treating bipolar depression. This may in part stem from the widely held but unproven belief that treatment with these drugs may trigger mania.
The study involved 366 patients with bipolar depression who were randomly selected to receive mood stabilizer drugs in combination with a standard antidepressant or inactive "placebo" for 26 weeks.
Durable recovery, defined as at least 8 consecutive weeks of having a non-depressed and non-manic mood, was achieved by 23.5 percent of patients in the combination therapy group, not significantly different from the 27.3 percent of patients in the comparison group, Dr. Gary S. Sachs, from Massachusetts General Hospital in Boston, and colleagues report.
Patients treated with antidepressants were no more likely than those given only mood stabilizers to experience a manic episode, at rates of 10.1 and 10.7 percent, respectively.
However, according to a related editorial, these new findings are likely to have little impact on physicians' opinions regarding the use of antidepressants in patients with bipolar disorder.
"Strongly held beliefs about the efficacy of antidepressants in treating bipolar depression, and their equally powerful risk of inducing mania, will not be put to rest by the study," Dr. Robert H. Belmaker, from Ben Gurion University of the Negev in Beersheva, Israel, predicts. He thinks the findings "will lead to less use of antidepressant medication in patients with bipolar depression, but treatment will continue to be individualized."
SOURCE: The New England Journal of Medicine, April 26, 2007.
