The International Society for bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders

Isabella Pacchiarotti, David J. Bond, Ross J. Baldessarini, Willem A. Nolen, Heinz Grunze, Rasmus W. Licht, Robert M. Post, Michael Berk, Guy M. Goodwin, Gary S. Sachs, Leonardo Tondo, Robert L. Findling, Eric A. Youngstrom, Mauricio Tohen, Juan Undurraga, Ana González-Pinto, Joseph F. Goldberg, Ayşegül Yildiz, Lori L. Altshuler, Joseph R. CalabresePhilip B. Mitchell, Michael E. Thase, Athanasios Koukopoulos, Francesc Colom, Mark A. Frye, Gin S. Malhi, Konstantinos N. Fountoulakis, Gustavo Vázquez, Roy H. Perlis, Terence A. Ketter, Frederick Cassidy, Hagop Akiskal, Jean Michel Azorin, Marc Valentí, Diego Hidalgo Mazzei, Beny Lafer, Tadafumi Kato, Lorenzo Mazzarini, Anabel Martínez-Aran, Gordon Parker, Daniel Souery, Ayşegül Özerdem, Susan L. McElroy, Paolo Girardi, Michael Bauer, Lakshmi N. Yatham, Carlos A. Zarate, Andrew A. Nierenberg, Boris Birmaher, Shigenobu Kanba, Rif S. El-Mallakh, Alessandro Serretti, Zoltan Rihmer, Allan H. Young, Georgios D. Kotzalidis, Glenda M. Macqueen, Charles L. Bowden, S. Nassir Ghaemi, Carlos Lopez-Jaramillo, Janusz Rybakowski, Kyooseob Ha, Giulio Perugi, Siegfried Kasper, Jay D. Amsterdam, Robert M. Hirschfeld, Flávio Kapczinski, Eduard Vieta

Research output: Contribution to journalArticle

331 Citations (Scopus)

Abstract

Objective: The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders.Method: Anexpert task force iteratively developed consensus through serial consensusbased revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. Results: There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Conclusions: Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to moodstabilizing medications.

Original languageEnglish (US)
Pages (from-to)1249-1262
Number of pages14
JournalAmerican Journal of Psychiatry
Volume170
Issue number11
DOIs
StatePublished - Nov 1 2013

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Advisory Committees
Bipolar Disorder
Antidepressive Agents
Consensus
Antidepressants
Safety
Bupropion
Tricyclic Antidepressive Agents
Serotonin Uptake Inhibitors

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Arts and Humanities (miscellaneous)

Cite this

Pacchiarotti, I., Bond, D. J., Baldessarini, R. J., Nolen, W. A., Grunze, H., Licht, R. W., ... Vieta, E. (2013). The International Society for bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. American Journal of Psychiatry, 170(11), 1249-1262. https://doi.org/10.1176/appi.ajp.2013.13020185

The International Society for bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. / Pacchiarotti, Isabella; Bond, David J.; Baldessarini, Ross J.; Nolen, Willem A.; Grunze, Heinz; Licht, Rasmus W.; Post, Robert M.; Berk, Michael; Goodwin, Guy M.; Sachs, Gary S.; Tondo, Leonardo; Findling, Robert L.; Youngstrom, Eric A.; Tohen, Mauricio; Undurraga, Juan; González-Pinto, Ana; Goldberg, Joseph F.; Yildiz, Ayşegül; Altshuler, Lori L.; Calabrese, Joseph R.; Mitchell, Philip B.; Thase, Michael E.; Koukopoulos, Athanasios; Colom, Francesc; Frye, Mark A.; Malhi, Gin S.; Fountoulakis, Konstantinos N.; Vázquez, Gustavo; Perlis, Roy H.; Ketter, Terence A.; Cassidy, Frederick; Akiskal, Hagop; Azorin, Jean Michel; Valentí, Marc; Mazzei, Diego Hidalgo; Lafer, Beny; Kato, Tadafumi; Mazzarini, Lorenzo; Martínez-Aran, Anabel; Parker, Gordon; Souery, Daniel; Özerdem, Ayşegül; McElroy, Susan L.; Girardi, Paolo; Bauer, Michael; Yatham, Lakshmi N.; Zarate, Carlos A.; Nierenberg, Andrew A.; Birmaher, Boris; Kanba, Shigenobu; El-Mallakh, Rif S.; Serretti, Alessandro; Rihmer, Zoltan; Young, Allan H.; Kotzalidis, Georgios D.; Macqueen, Glenda M.; Bowden, Charles L.; Ghaemi, S. Nassir; Lopez-Jaramillo, Carlos; Rybakowski, Janusz; Ha, Kyooseob; Perugi, Giulio; Kasper, Siegfried; Amsterdam, Jay D.; Hirschfeld, Robert M.; Kapczinski, Flávio; Vieta, Eduard.

In: American Journal of Psychiatry, Vol. 170, No. 11, 01.11.2013, p. 1249-1262.

Research output: Contribution to journalArticle

Pacchiarotti, I, Bond, DJ, Baldessarini, RJ, Nolen, WA, Grunze, H, Licht, RW, Post, RM, Berk, M, Goodwin, GM, Sachs, GS, Tondo, L, Findling, RL, Youngstrom, EA, Tohen, M, Undurraga, J, González-Pinto, A, Goldberg, JF, Yildiz, A, Altshuler, LL, Calabrese, JR, Mitchell, PB, Thase, ME, Koukopoulos, A, Colom, F, Frye, MA, Malhi, GS, Fountoulakis, KN, Vázquez, G, Perlis, RH, Ketter, TA, Cassidy, F, Akiskal, H, Azorin, JM, Valentí, M, Mazzei, DH, Lafer, B, Kato, T, Mazzarini, L, Martínez-Aran, A, Parker, G, Souery, D, Özerdem, A, McElroy, SL, Girardi, P, Bauer, M, Yatham, LN, Zarate, CA, Nierenberg, AA, Birmaher, B, Kanba, S, El-Mallakh, RS, Serretti, A, Rihmer, Z, Young, AH, Kotzalidis, GD, Macqueen, GM, Bowden, CL, Ghaemi, SN, Lopez-Jaramillo, C, Rybakowski, J, Ha, K, Perugi, G, Kasper, S, Amsterdam, JD, Hirschfeld, RM, Kapczinski, F & Vieta, E 2013, 'The International Society for bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders', American Journal of Psychiatry, vol. 170, no. 11, pp. 1249-1262. https://doi.org/10.1176/appi.ajp.2013.13020185
Pacchiarotti, Isabella ; Bond, David J. ; Baldessarini, Ross J. ; Nolen, Willem A. ; Grunze, Heinz ; Licht, Rasmus W. ; Post, Robert M. ; Berk, Michael ; Goodwin, Guy M. ; Sachs, Gary S. ; Tondo, Leonardo ; Findling, Robert L. ; Youngstrom, Eric A. ; Tohen, Mauricio ; Undurraga, Juan ; González-Pinto, Ana ; Goldberg, Joseph F. ; Yildiz, Ayşegül ; Altshuler, Lori L. ; Calabrese, Joseph R. ; Mitchell, Philip B. ; Thase, Michael E. ; Koukopoulos, Athanasios ; Colom, Francesc ; Frye, Mark A. ; Malhi, Gin S. ; Fountoulakis, Konstantinos N. ; Vázquez, Gustavo ; Perlis, Roy H. ; Ketter, Terence A. ; Cassidy, Frederick ; Akiskal, Hagop ; Azorin, Jean Michel ; Valentí, Marc ; Mazzei, Diego Hidalgo ; Lafer, Beny ; Kato, Tadafumi ; Mazzarini, Lorenzo ; Martínez-Aran, Anabel ; Parker, Gordon ; Souery, Daniel ; Özerdem, Ayşegül ; McElroy, Susan L. ; Girardi, Paolo ; Bauer, Michael ; Yatham, Lakshmi N. ; Zarate, Carlos A. ; Nierenberg, Andrew A. ; Birmaher, Boris ; Kanba, Shigenobu ; El-Mallakh, Rif S. ; Serretti, Alessandro ; Rihmer, Zoltan ; Young, Allan H. ; Kotzalidis, Georgios D. ; Macqueen, Glenda M. ; Bowden, Charles L. ; Ghaemi, S. Nassir ; Lopez-Jaramillo, Carlos ; Rybakowski, Janusz ; Ha, Kyooseob ; Perugi, Giulio ; Kasper, Siegfried ; Amsterdam, Jay D. ; Hirschfeld, Robert M. ; Kapczinski, Flávio ; Vieta, Eduard. / The International Society for bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. In: American Journal of Psychiatry. 2013 ; Vol. 170, No. 11. pp. 1249-1262.
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abstract = "Objective: The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders.Method: Anexpert task force iteratively developed consensus through serial consensusbased revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. Results: There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Conclusions: Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to moodstabilizing medications.",
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T1 - The International Society for bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders

AU - Pacchiarotti, Isabella

AU - Bond, David J.

AU - Baldessarini, Ross J.

AU - Nolen, Willem A.

AU - Grunze, Heinz

AU - Licht, Rasmus W.

AU - Post, Robert M.

AU - Berk, Michael

AU - Goodwin, Guy M.

AU - Sachs, Gary S.

AU - Tondo, Leonardo

AU - Findling, Robert L.

AU - Youngstrom, Eric A.

AU - Tohen, Mauricio

AU - Undurraga, Juan

AU - González-Pinto, Ana

AU - Goldberg, Joseph F.

AU - Yildiz, Ayşegül

AU - Altshuler, Lori L.

AU - Calabrese, Joseph R.

AU - Mitchell, Philip B.

AU - Thase, Michael E.

AU - Koukopoulos, Athanasios

AU - Colom, Francesc

AU - Frye, Mark A.

AU - Malhi, Gin S.

AU - Fountoulakis, Konstantinos N.

AU - Vázquez, Gustavo

AU - Perlis, Roy H.

AU - Ketter, Terence A.

AU - Cassidy, Frederick

AU - Akiskal, Hagop

AU - Azorin, Jean Michel

AU - Valentí, Marc

AU - Mazzei, Diego Hidalgo

AU - Lafer, Beny

AU - Kato, Tadafumi

AU - Mazzarini, Lorenzo

AU - Martínez-Aran, Anabel

AU - Parker, Gordon

AU - Souery, Daniel

AU - Özerdem, Ayşegül

AU - McElroy, Susan L.

AU - Girardi, Paolo

AU - Bauer, Michael

AU - Yatham, Lakshmi N.

AU - Zarate, Carlos A.

AU - Nierenberg, Andrew A.

AU - Birmaher, Boris

AU - Kanba, Shigenobu

AU - El-Mallakh, Rif S.

AU - Serretti, Alessandro

AU - Rihmer, Zoltan

AU - Young, Allan H.

AU - Kotzalidis, Georgios D.

AU - Macqueen, Glenda M.

AU - Bowden, Charles L.

AU - Ghaemi, S. Nassir

AU - Lopez-Jaramillo, Carlos

AU - Rybakowski, Janusz

AU - Ha, Kyooseob

AU - Perugi, Giulio

AU - Kasper, Siegfried

AU - Amsterdam, Jay D.

AU - Hirschfeld, Robert M.

AU - Kapczinski, Flávio

AU - Vieta, Eduard

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Objective: The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders.Method: Anexpert task force iteratively developed consensus through serial consensusbased revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. Results: There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Conclusions: Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to moodstabilizing medications.

AB - Objective: The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders.Method: Anexpert task force iteratively developed consensus through serial consensusbased revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. Results: There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Conclusions: Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to moodstabilizing medications.

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