SYMPOSIA

References:
Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Abstracts of the Invited Speakers
1. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: A meta-analysis of data submitted to
the Food and Drug Administration. PLoS Medicine [serial on the Internet]. 2008; 5(2): Available from: http://medicine.plosjournals.org/perlserv/?request=getdocument&doi=10.1371/journal.pmed.0050045.
2. Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J. Antidepressant Drug Effects and Depression Severity: A Patient-Level Metaanalysis.
Journal of the American Medical Association2010;303(1):47-53.
3. Andrews P, Kornstein S, Halberstadt L, Gardner C, Neale MC. Blue again: Perturbational effects of antidepressants suggest monoaminergic homeostasis in major
depression. Frontiers in Psychology. [Original Research]. 2011;2.
4. Ruhé HG, Mason NS, Schene AH. Mood is indirectly related to serotonin, norepinephrine and dopamine levels in humans: a meta-analysis of monoamine depletion
studies. Molecular Psychiatry2007;12:331-59.
5. Pigott HE, Leventhal AM, Alter GS, Boren JJ. Efficacy and Effectiveness of Antidepressants: Current Status of Research Psychotherapy and Psychosomatics2010;70:267-79.
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S38-9
[MD-03]
Antidepressants are useful in the treatment of bipolar disorders
Selçuk Kırlı
Department of Psychiatry, Uludag University, Bursa, Turkey
E-mail: kselcuk@uludag.edu.tr
Using antidepressant drugs in Bipolar Depression (BD) has not been adequately considered or explored. This matter is indeed an area of
ambiguity which should to be clarified as soon as possible due to the following facts concerning bipolar disorder:
• It is repetitive and progresses relatively slowly
• It tends to become chronic
• It involves a high risk of suicide
• It causes more disability than the other variations of the disease (1).
Treatment manuals, expert views and practices do not fully agree with each other on the issue of whether or not it is appropriate to
use antidepressant (AD) drugs to treat BD. There are also differences in the manuals of various countries although they have similar
approaches. Americans and Canadians, in particular, strictly oppose the use of ADs in BD. They generally recommend using mood
stabilizers (MSs) in treating less severe depressions, using ADs alongside these drugs only in severe depressions and discontinuing ADs as
soon as possible. In Germany and some other countries, there is a long and firm tradition of using ADs as a first line treatment (2). Despite
different approaches, it is a fact that the decision to use antidepressant drugs in BD is not easy.
The difficulty might stem from a number of reasons including:
• Studies supporting the effectiveness of ADs in BD are few in number and they are not sufficient to approve the use of ADs in this area.
• Although the issue has not been supported by placebo-controlled studies, there is a common belief that ADs cause manic transitions and rapid cycles (3).
The matters of debate that may clarify this issue can be summarized as follows (2):
• Transition to mania and rapid cycling are significant phenomena in Bipolar Disorder (BD).
• The issue of suicide is, in fact, of minimal importance in BD.
• The efficacy of antidepressants in BD has not been supported by satisfactory evidence.
• MSs having an AD effect in BD has been supported by satisfactory evidence.
Here are some brief answers to the matters of debate:
• Like ADs, MSs have also not been officially approved in the treatment of BD. It is worthwhile to discuss the new generation antipsychotics
(NGAPs) which have been approved in this context.
• The data on manic transition and rapid cycling are problematic for the use of tricyclics to a certain extent; the data obtained from modern
antidepressants have largely removed this issue from being a special problem area. There are also other alternatives to diminish the risk (4).
• The antidepressant effect is directed towards the syndrome, thus these drugs are also effective in BD, but there are no noteworthy
positive data on this issue for MSs other than a slight benefit obtained from Lithium.
• The issues of suicide and chronicity cause a greater risk than all other issues in terms of contribution to a bad result for BD.
In view of these and similar benefit/risk comparisons, we can conclude that it is reasonable and necessary to use ADs as a single agent or
in combination with MSs or NGAPs in the treatment of BD. This approach is already commonly applied in practice.
Key words: Bipolar disorder, antidepressants, depression
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