Antidepressants were superior to placebo in reducing new depressive episodes in bipolar disorders without increasing risk of new manic/hypomanic episodes either used as monotherapy or in combination with MS .
Subgroup analyses revealed that greater benefit and lower risk may be achieved in BD II than in BD I. However , compared with MS monotherapy , AD monotherapy significantly increased the risk of affective switch with no improvement in prophylaxis of new depressive episodes .
CONCLUSIONS Reduced new depressive episodes may be achieved by long-term AD treatment with no significantly increased risk of new manic/hypomanic episodes in BD , particularly in BD II .
The elevated risk of affective switch  of AD monotherapy compared with MS monotherapy may be contributed to the protective effect of MS in diminishing manic/hypomanic episodes .
OBJECTIVE Efficacy and safety of long-term use of antidepressants ( AD ) in bipolar disorder ( BD ) patients remains highly controversial .
Here we performed a meta- analysis of r and omized controlled trials ( RCTs ) exploring the efficacy and safety of long-term AD use in BD patients .
Longitudinal course of bipolar I disorder: duration of mood episodes.
CONTEXT The phenomenology of bipolar I disorder affects treatment and prognosis . OBJECTIVE To describe the duration of bipolar I mood episodes and factors associated with recovery from these episodes . DESIGN Subjects with Research Diagnostic Criteria bipolar I disorder were prospect ively followed up for as long as 25 years . The probability of recovery over time from multiple successive mood episodes was examined with survival analytic techniques , including a mixed-effects grouped-time survival model . SETTING Five US academic medical centers . PARTICIPANTS Two hundred nineteen subjects with bipolar I disorder . MAIN OUTCOME MEASURES Level of psychopathology was assessed with the Longitudinal Interval Follow-up Evaluation every 6 months for the first 5 years of follow-up and annually thereafter . RESULTS The median duration of bipolar I mood episodes was 13 weeks . More than 75 % of the subjects recovered from their mood episodes within 1 year of onset . The probability of recovery was significantly less for an episode with severe onset ( psychosis or severe psychosocial impairment in week 1 of the episode ) ( hazard ratio [ HR ] = 0.746 ; 95 % confidence interval [ CI ] , 0.578 - 0.963 ; P = .02 ) and for subjects with greater cumulative morbidity ( total number of years spent ill with any mood episode ) ( HR = 0.917 ; 95 % CI , 0.886 - 0.948 ; P < .001 ) . Compared with the probability of recovery from a major depressive episode , there was a significantly greater probability of recovery from an episode of mania ( HR = 1.713 ; 95 % CI , 1.373 - 2.137 ; P < .001 ) , hypomania ( HR = 4.502 ; 95 % CI , 3.466 - 5.849 ; P < .001 ) , or minor depression ( HR = 2.027 ; 95 % CI , 1.622 - 2.534 ; P < .001 ) and , conversely , a significantly reduced probability of recovery from a cycling episode ( switching from one pole to the other without an intervening period of recovery ) ( HR = 0.438 ; 95 % CI , 0.351 - 0.548 ; P < .001 ) . CONCLUSIONS The median duration of bipolar I mood episodes was 13 weeks , and the probability of recovery was significantly decreased for cycling episodes , mood episodes with severe onset , and subjects with greater cumulative morbidity
Antidepressants were superior to placebo in reducing new depressive episodes in bipolar disorders without increasing risk of new manic/hypomanic episodes either used as monotherapy or in combination with MS .
Subgroup analyses revealed that greater benefit and lower risk may be achieved in BD II than in BD I. However , compared with MS monotherapy , AD monotherapy significantly increased the risk of affective switch with no improvement in prophylaxis of new depressive episodes .
CONCLUSIONS Reduced new depressive episodes may be achieved by long-term AD treatment with no significantly increased risk of new manic/hypomanic episodes in BD , particularly in BD II .
The elevated risk of affective switch  of AD monotherapy compared with MS monotherapy may be contributed to the protective effect of MS in diminishing manic/hypomanic episodes .
OBJECTIVE Efficacy and safety of long-term use of antidepressants ( AD ) in bipolar disorder ( BD ) patients remains highly controversial .
Here we performed a meta- analysis of r and omized controlled trials ( RCTs ) exploring the efficacy and safety of long-term AD use in BD patients .