Antidepressants in Bipolar Depression: Addressing The Controversy

<jats:p>Antidepressants have small short-term efficacy in bipolar depression (SMD 0.2–0.4), comparable to lithium and slightly below atypical antipsychotics. Quetiapine leads at 0.35 with no negative trials. CANMAT Guidelines recommend discontinuing antidepressants within eight weeks due to risk, not loss of efficacy. Continuing beyond eight weeks nearly doubles the one-year incidence of manic recurrence. The risk-benefit balance for antidepressants in bipolar is tipped more by risk than efficacy Despite guideline recommendations, about 50% of bipolar patients remain on antidepressants long term.</jats:p>