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The treatment of bipolar depression has long been recognized as problematic because antidepressants have limited efficacy and a great propensity to switch patients into mania. This chart review from Massachusetts General Hospital describes 20 bipolar patients treated with paroxetine since its release in 1993.
At the time of paroxetine treatment, all patients (13 women and 7 men) met DSM-III-R diagnostic criteria for both bipolar disorder and current major depression. Nineteen had bipolar I depression and one had bipolar II depression. A striking 85% of patients had switched to hypomania or mania with previous antidepressant treatment, and 85% had a family history of bipolar disorder. Prior to treatment with paroxetine, all patients had faile…