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Antidepressants and Antipsychotics in the Long-Term Treatment of Bipolar Disorder

Vivek Kusumakar, MD, FRCPC

Published: October 1, 2002

Article Abstract

Antidepressants and antipsychotics are frequently used as mood stabilizers in the treatment ofbipolar disorder. As common as these agents appear to be in bipolar treatment, the literature containslittle research on their efficacy and safety in the long term. Most of the available literature on longtermantidepressant treatment focuses on tricyclic antidepressants, which have been shown to inducemania or hypomania. Rapid cycling is another side effect that is associated with antidepressanttreatment in bipolar disorder. Antidepressants do not appear to be any more effective than mood stabilizersin treating bipolar depression. Conventional antipsychotics in depot formulations have beenshown to be an effective treatment, but conventional antipsychotics may cause tardive dyskinesia. Thenovel antipsychotics clozapine, risperidone, and olanzapine appear to be efficacious; however, theirside effect profiles include agranulocytosis and weight gain. Given the frequency with which antidepressantsand antipsychotics are used in bipolar disorder and that bipolar disorder is a chronic diseaserequiring maintenance treatment, more research on the use of these types of agents in long-term treatmentis needed. Until more evidence is available on the long-term treatment outcomes, cliniciansshould be aware that the adverse events associated with antidepressants and antipsychotics may outweighthe benefit, if any, of the use of these agents in bipolar disorder.

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