HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS Psychiatric Bulletin Advances in Psychiatric Treatment All RCPsych Journals		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Data supplement Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Related articles in BJP Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Post, R. M. Articles by Mintz, J. Search for Related Content PubMed PubMed Citation Articles by Post, R. M. Articles by Mintz, J.

Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline

Department of Health and Human Services, National Institute of Mental Health, Bethesda, Maryland

L. L. Altshuler, MD

UCLA Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine and West Los Angeles VA Medical Center, Los Angeles, California

G. S. Leverich, MSW

Department of Health and Human Services, National Institute of Mental Health, Bethesda, Maryland

M. A. Frye, MD

UCLA Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine and West Los Angeles VA Medical Center, Los Angeles, California

W. A. Nolen, MD

University Hospital Groningen, Groningen, and Altrecht Institute of Mental Health Care, Utrecht

R. W. Kupka, MD, PhD

Altrecht Institute of Mental Health Care, Utrecht, The Netherlands

T. Suppes, MD

University of Texas, Southwestern Medical Center, Dallas, Texas

S. McElroy, MD and P. E. Keck, MD

Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio

K. D. Denicoff, MD

Department of Health and Human Services, National Institute of Mental Health, Bethesda, Maryland, USA

H. Grunze, MD

University of Munich, Munich

J. Walden, MD

University of Freiberg, Freiberg, Germany

C. M. R. Kitchen, PhD

Department of Biostatistics, School of Public Health, UCLA, Los Angeles, California

J. Mintz, PhD

UCLA Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine and West Los Angeles VA Medical Center, Los Angeles, California, USA

Correspondence: Dr Robert M. Post, Bldg 10, Room 3S239, 10 Center Drive MSC1272, Bethesda, Maryland 20892-1272, USA. Tel: +1 301 496 4805; fax: +1 301 402 0052; email: postr{at}mail.nih.gov

Declaration of interest None.

Background Few studies have examined the relative risks of switching into hypomania or mania associated with second-generation antidepressant drugs in bipolar depression.

Aims To examine the relative acute effects of bupropion, sertraline and venlafaxine as adjuncts to mood stabilisers.

Method In a 10-week trial, participants receiving out-patient treatment for bipolar disorder (stratified for rapid cycling) were randomly treated with a flexible dose of one of the antidepressants, or their respective matching placebos, as adjuncts to mood stabilisers.

Results A total of 174 adults with bipolar disorder I, II or not otherwise specified, currently in the depressed phase, were included. All three antidepressants were associated with a similar range of acute response (49-53%) and remission (34-41%). There was a significantly increased risk of switches into hypomania or mania in participants treated with venlafaxine compared with bupropion or sertraline.

Conclusions More caution appears indicated in the use of venlafaxine rather than bupropion or sertraline in the adjunctive treatment of bipolar depression, especially if there is a prior history of rapid cycling.

Related articles in BJP:

From the Editor's desk

Peter Tyrer
BJP 2006 189: 200. [Full Text]  

Highlights of this issue

Kimberlie Dean
BJP 2006 189: A5. [Full Text]  

This article has been cited by other articles:

				R. H. Belmaker Modafinil Add-On in the Treatment of Bipolar Depression Am J Psychiatry, August 1, 2007; 164(8): 1143 - 1145. [Full Text] [PDF]

				C. de DIOS and E. EZQUIAGA Manic Switching in Patients Receiving Duloxetine Am J Psychiatry, July 1, 2007; 164(7): 1121 - 1121. [Full Text] [PDF]

				G. S. Sachs, A. A. Nierenberg, J. R. Calabrese, L. B. Marangell, S. R. Wisniewski, L. Gyulai, E. S. Friedman, C. L. Bowden, M. D. Fossey, M. J. Ostacher, et al. Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression N. Engl. J. Med., April 26, 2007; 356(17): 1711 - 1722. [Abstract] [Full Text] [PDF]

				D. J Smith and J. T Walters Bipolarity is important during treatment with antidepressants BMJ, February 17, 2007; 334(7589): 327 - 327. [Full Text] [PDF]

				G. S. Sachs Bipolar Disorder Clinical Synthesis: Where Does the Evidence Lead? Focus, January 1, 2007; 5(1): 3 - 13. [Abstract] [Full Text] [PDF]

				Bibliography BIPOLAR DISORDER Focus, January 1, 2007; 5(1): 40 - 43. [Full Text] [PDF]

				P. TYRER The British Journal of Psychiatry, December 1, 2006; 189(6): 576 - 576. [Full Text] [PDF]