Antidepressant treatment for depression with bipolar disorder

There are difficulties in treating depression in bipolar disorder. It is believed that the use of antidepressants leads to phase inversion, aggravates the course of the disease and leads to the risk of complications.

 In 25% of patients with bipolar affective disorder, the uncontrolled use of antidepressants leads to frequent phase changes, the formation of a long course of the disease, and a rapid phase change.

But antidepressants are often used despite the risk of phase inversion and poor prognosis.

To treat depression in bipolar disorder, use:

· Tricyclic antidepressants;       

· A combination of tricyclic antidepressants with normotimics ;       

· Combination of TCAs with atypical antipsychotics;       

· Selective serotonin reuptake inhibitor (SIOZ);       

· Monoamine oxidase (MAO) inhibitors .       

A large number of patients experience an improvement in well-being with the use of antidepressants. But at the same time, there is no reliable data on whether the drug affects the improvement of patients’ condition or spontaneous remission occurs.  

The FDA analysis revealed the falsity of publications of clinical trials on the effectiveness of antidepressants. Some studies with negative effects were not published, or negative results were passed off as positive. Phase inversion was seen as a positive effect.

New generation antidepressants have advantages over tricyclic antidepressants, but it is still necessary to limit the appointment of thymoanaleptics (antidepressants) and combine them with normotimics that prevent phase inversion . 

Do not use repeated administration of antidepressants, in which phase inversion occurs. 

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