The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders
By I. Pacchiarotti, D. Bond, R. Baldessarini, W. Nolen, H. Grunze, R. Licht, R. Post, Michael Berk, Guy M. Goodwin, G. Sachs and 57 more. American Journal of Psychiatry, 2013
664 citations recorded by the source corpus.
Objective The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. Method An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. Results There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Conclusions Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.
Subfields: Pharmacology, Psychiatry and Mental health
View Paper: https://www.semanticscholar.org/paper/046b897f1dfb5e910cf0ee8915745eddd1b773bd
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Citations in the corpus
- Using the Delphi expert consensus method in mental health research (2015, background): “Here is an example: •• A study on antidepressant use in bipolar disorders derived items from a literature search on PubMed (Pacchiarotti et al., 2013).”
- Evidence-based guidelines for treating bipolar disorder: revised third edition Recommendations from the British Association for Psychopharmacology (2009, neutral): “These and the few other relevant findings are far from compel-ling (Ghaemi et al., 2001; Pacchiarotti et al., 2013).”
- Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines (2015, background): “The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders concluded that the evidence that patients with bipolar depression benefit from antidepressants is poor (Pacchiarotti et al., 2013).”
- Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (2015, background): “As the recent ISBD task force report noted, “There is a striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder” (Pacchiarotti et al., 2013a).”