Which Antidepressants Flick the Switch?

Abstract

Objective: The Black Dog Institute seeks to address issues of relevance to the clinical management of those with a mood disorder. This overview considers the capacity of antidepressant drugs, and particularly the new classes, to induce manic switching in depressed patients. Method: Relevant literature is reviewed. Results: It is unclear whether antidepressant drugs from any of the classes induce switching in unipolar depressed patients. In bipolar depressed patients, the broad-spectrum tricyclic and monoamine oxidase inhibitor drugs present a clear risk of switching, the selective serotonin re-uptake inhibitors do not appear (at standard doses) to increase the risk, while the capacity of the dual action (serotonergic and noradrenergic) drugs to induce switching remains unestablished but may be slight. Conclusions: As switching induced by narrow action antidepressants does not appear to present a substantive causal risk, clinicians can have confidence in prescribing certain antidepressants for managing bipolar depression, and without any necessity to first prescribe a mood stabilizer to pre-empt switching.