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Prescribing antidepressants to depressed patients with bipolar II disorder has long raised concerns about switches to hypomania/mania, particularly in patients with rapid cycling. In addition, some research has shown that antidepressants are ineffective for bipolar depression. Revisiting these questions, investigators analyzed data from a randomized, controlled, two-phase comparison of venlafaxine (initially 37.5 mg/day, gradually increasing to ≤375 mg/day by week 4) or lithium monotherapy (starting dose, 300 mg/day; maximum, 1200 mg/day) in 129 patients with bipolar II depression, 60 with rapid cycling.
The rapid-cycling and nonrapid-cycling patients were roughly evenly distributed between the two medication arms. In the acute phase, a high…