Mood Switch in Bipolar Depression: Comparison of Adjunctive Venlafaxine, Bupropion and Sertraline

Mood Switch in Bipolar Depression: Comparison of Adjunctive Venlafaxine, Bupropion and Sertraline
Br J Psychiatry. 2006 Aug;189:124-31.

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.