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 .
Impact of antidepressant continuation after acute positive or partial treatment response for bipolar depression: a blinded, randomized study.
OBJECTIVE To assess long-term outcome in bipolar disorder , subjects were prospect ively followed after receiving acute treatment for bipolar depression . METHOD Eighty-three out patients with DSM-IV bipolar depression who were enrolled between March 1996 and November 2002 and were treated in a 10-week acute double-blind antidepressant treatment trial agreed to participate in a 1-year double-blind continuation of their medication . In the acute antidepressant treatment trial , subjects were treated with a mood stabilizer plus 1 of 3 r and omly assigned antidepressants .  Sixty-one subjects had attained an acute positive antidepressant response ( 50 % improvement on the Inventory for Depressive Symptomatology [ IDS ] or 2-point improvement on the Clinical Global Impression for Bipolar Disorder [ CGI-BP ] ) and 22 subjects achieved only acute partial improvement at the end of the 10-week acute trial . In the blinded continuation phase immediately following the acute trial , subjects continued on the same medications and were rated monthly for up to 1 year using the IDS , CGI-BP , and the Young Mania Rating scale . RESULTS At study endpoint , 42 ( 69 % ) of the 61 acute positive responders maintained positive response and 32 ( 53 % ) achieved remission . Compared to the acute positive responders , 6 ( 27 % ) of the 22 acute partial responders had achieved positive treatment response at study endpoint ( p < .001 ) . Eight acute positive responders ( 13 % ) and 5 acute partial responders ( 22 % ) developed mania . CONCLUSION Patients who achieve a positive acute antidepressant response to 10 weeks of antidepressant treatment adjunctive to a mood stabilizer will probably maintain response with the same continued treatment . Patients who achieve only a partial acute antidepressant response are less likely to further improve when the same treatment is sustained . The switch rate into mania for patients being treated with an antidepressant adjunctive to a mood stabilizer is not higher than the reported rate for patients on mood stabilizer monotherapy
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 .