Antidepressants provide no extra benefit to those already on mood stabilizers for bipolar disorder.
Before participants were randomized to one of two antidepressants — bupropion (Wellbutrin) or paroxetine (Paxil) — or to a placebo, doctors trained in the treatment of bipolar disorder adjusted participants’ mood stabilizer doses to optimal levels, ensuring that they were receiving the most appropriate amount.
After about 26 weeks, Sachs and colleagues found that 24 percent of those who had been randomized to the antidepressants stayed well for at least eight consecutive weeks — the study’s stringent standard for recovery; 27 percent of those randomized to a placebo stayed well long enough to meet the eight-week recovery standard, indicating no difference between adding an antidepressant or adding placebo. In addition, about 10 percent of each group experienced emerging symptoms of mania, indicating that the antidepressants did not trigger a manic switch any more than placebo. Finally, when comparing the two antidepressants to each other, both showed similar rates of response and manic switch.