Antidepressants in bipolar I disorder: Never as monotherapy

摘要

Bipolar depression is difficult to treat and prevent. Were this not so, the controversy about the use of antidepressants in patients with bipolar disorder would have faded away long ago. Physicians want the best for their patients, but they are often faced with difficult decisions related the benefit-risk profile of a treatment. And increasingly, patients have their own views on what they expect from treatment and which risks are worth taking and which not. At the end of the day, prescribing a treatment is an individualized decision based on knowledge, experience, empathy, and common sense. In an era of sophisticated genetic studies and dazzling neuroimaging tools, what makes a good psychiatrist is still sound clinical judgment. Last year, the Journal published an international consensus document on the use of antidepressants in bipolar disorder (1) that summarized the current evidence on their controversial efficacy and safety in bipolar disorder and provided a number of recommendations based on the state of the art. Recommendation 4 was "Antidepressant monotherapy should be avoided in bipolar I disorder" (1).