Add-On Antidepressants for Bipolar Depression?

Although depression is the leading cause of disability and death in bipolar illness, current medications are more effective for manic than depressive episodes. This placebo-controlled trial examined whether antidepressants, taken with mood stabilizers, reduced depressive symptoms without increasing the risk for mania.

A total of 366 subjects with a major depressive episode associated with bipolar disorder were randomized to placebo or their choice of paroxetine (median dose, 30 mg) or bupropion (median dose, 300 mg). Study clinicians selected mood stabilizers (e.g., lithium, valproate) and made other clinical decisions. Patients had multiple medical and psychiatric comorbidities.

Antidepressant and placebo recipients had similar rates of dura…