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Louise Chang, MD
March 28, 2007 -- Adding antidepressants to mood-stabilizing drugs may not
help -- or hurt -- the treatment of bipolardepression, the depressive phase of
Researchers report that news online in The New England Journal of
Medicine. They included Gary Sachs, MD, of Massachusetts General Hospital
and Harvard Medical School.
The study's results "indicate that careful management of mood-stabilizer
medications is a reasonable alternative to adding antidepressant medication for
treating bipolar depression," Sachs says in a news release from the
National Institute of Mental Health.
The study included 366 bipolar depression patients at 22 centers across the
First, the researchers made sure all of the patients were taking appropriate
doses of mood-stabilizing drugs such as lithium. Next, they split the patients
into two groups.
One group received an inactive sugar pill (placebo) in addition to their
Patients in the other group received one of two antidepressants --
paroxetine or bupropion -- along with the mood-stabilizing drugs.
Paroxetine is sold generically and under the brand name Paxil. Bupropion is
sold generically and under the brand name Wellbutrin XL. The study doesn't
specify whether the generic or brand-name versions were used.
Paroxetine and bupropion are commonly used with mood stabilizers to treat
bipolar depression, but the FDA hasn't approved any antidepressant to treat the
disorder, note Sachs and colleagues.
Both patient groups took their assigned drugs for up to 26 weeks.
During that time, the researchers counted how many in each group had eight
consecutive weeks without major mood swings.
Adding antidepressants to the mood-stabilizing drugs didn't appear to affect
About 23% of the antidepressant group met the study's benchmark (eight
consecutive weeks without major mood swings), compared with 27% of the placebo
The difference was so small that it was not significant, the researchers
note. They found no advantage for either antidepressant over a placebo.
However, the antidepressant group also had no more side effects or manic
episodes than the group taking a placebo, the study shows.
The findings "come as a surprise," since European studies have
supported antidepressants' efficacy in treating bipolar depression, says an
online editorial in The New England Journal of Medicine written by R.H.
Belmaker, MD. Belmaker works at Ben Gurion University and Beersheva Mental
Health Center in Beersheva, Israel.
Further studies are needed to see if some antidepressants are more helpful
than others in treating bipolar depression, Belmaker says.
Sachs and colleagues also call for more research, especially long-term
studies since their study was relatively short.
The study was funded by the National Institute of Mental Health. In the
journal, Sachs and colleagues note financial ties to various drug companies;
Belmaker says he has no potential conflicts of interest.
The study and editorial appear in the journal's "Online First"
edition and will be published in its print edition on April 26.
SOURCES: Sachs, G. The New England Journal of Medicine, March 28,
2007; Online First edition. Belmaker, R. The New England Journal of
Medicine, March 28, 2007; Online First edition. News release, National
Institute of Mental Health. News release, Baylor College of Medicine.
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