Antidepressants in Bipolar Depression: Still Controversial After All These Years

Abstract

The use of antidepressants in the treatment of bipolar disorder (BD) has been one of the more enduring controversies in the field. Antidepressants continue to be one of the most widely used classes of psychotropic agents in BD and are still prominently featured in most treatment guidelines, despite the limited and inconsistent evidence supporting their safety and efficacy in the treatment and prevention of episodes of bipolar 1 depression. Herein, the authors review the clinical and meta-analytical evidence on the efficacy and safety of antidepressants in BD types 1 and 2. Clinicians should be aware of the potential risks and benefits of anti-depressants for patients with BD, as well as the scenarios and patients' characteristics that can affect treatment outcomes. [ Psychiatr Ann . 2023;53(2):63–67.]