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 discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up.
OBJECTIVE While guidelines for treating patients with bipolar depression recommend discontinuing antidepressants within 6 months after remission , few studies have assessed the implication s of this strategy on the risk for depressive relapse . This study examined the effect of antidepressant discontinuation or continuation on depressive relapse risk among bipolar subjects successfully treated for an acute depressive episode . METHOD Eighty-four subjects with bipolar disorder who achieved remission from a depressive episode with the addition of an antidepressant to an ongoing mood stabilizer regimen were followed prospect ively for 1 year . The risk of depressive relapse among 43 subjects who stopped antidepressant treatment within 6 months after remission ( " discontinuation group " ) was compared with the risk among 41 subjects who continued taking antidepressants beyond 6 months  ( " continuation group " ) . RESULTS A Cox proportional hazards regression analysis indicated that shorter antidepressant exposure time following successful treatment was associated with a significantly shorter time to depressive relapse . Furthermore , patients who discontinued antidepressant treatment within the first 6 months after remission experienced a significantly shorter period of euthymia before depressive relapse over the length of 1-year follow-up . One year after successful antidepressant response , 70 % of the antidepressant discontinuation group experienced a depressive relapse compared with 36 % of the continuation group . By the 1-year follow-up evaluation , 15 ( 18 % ) of the 84 subjects had experienced a manic relapse ; only six of these subjects were taking an antidepressant at the time of manic relapse . CONCLUSIONS The risk of depressive relapse in patients with bipolar illness was significantly associated with discontinuing antidepressants soon after remission . The risk of manic relapse was not significantly associated with continuing use of antidepressant medication and , overall , was substantially less than the risk of depressive relapse . Maintenance of antidepressant treatment in combination with a mood stabilizer may be warranted in some patients with bipolar disorder
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 .