In patients with bipolar disorder, the use of antidepressants without mood stabilisers has been thought to have the potential to induce mania, mixed affective states and rapid cycling bipolar disorder. Since both mixed states and rapid cycling are associated with an increased risk of suicide, the use of antidepressants in the treatment of bipolar disorder has been questioned. In this paper the evidence and the guidelines for the use of antidepressants in the management of depressive episodes in bipolar disorder are reviewed. The evidence suggests that the risk of mania is not significant with the use of certain antidepressants. However, there is emerging evidence that antidepressants have limited effectiveness in treating bipolar depression. We suggest antidepressants should not be the first choice of treatment for depressive episodes in bipolar disorder and if used should always be given in combination with mood stabilisers. Other compounds such as quetiapine and lamotrigine appear to be of more use in the treatment of bipolar depression.
Keywords: antidepressants, bipolar disorder, mood stabilisers, quetiapine, lamotrigine