Study: Anti-Depressants Cause Mania In Bipolar Disorder

Regular readers know that I've been hammering on the use of anti-depressants in bipolar disorder and how the drugs cause mania and hypomania in some patients. My view is that these drugs should go from being standard treatment in bipolar disorder to being used as rarely as possible. Some researchers such as Tufts' Nassir Ghaemi have been brave enough to write about this as well, and during the recent NIH-funded STEP-BD study, we learned that placebo outperforms anti-depressants in treating bipolar depression and that the drugs increased manic symptoms severity. All of these points run counter to what most psychiatrists and doctors think they know about anti-depressant use in bipolar disorder. Hell, as I noted yesterday, there are docs who uses drug-caused mania to diagnose bipolar disorder (crazy, but true).

Last week, a new study came out in the American Journal of Psychiatry and made it crystal clear that there's drug-induced mania and hypomania in the land. The study was lead-authored by Mark Frye of the Mayo Clinic and you should check out his and his co-authors' reported pharma funding at the end of the study, because it's a long list.

That said, the study found that in a trial of anti-depressants in 176 adults, 44 people (25 percent) developed treatment-emergent mania, 44 people (25 percent) had no response whatsoever to anti-depressants used during the 10-week trial while 84 had some level of response to anti-depressants. Drugs used were Wellbutrin, Zoloft and Effexor. One wonders if the treatment-induced mania number wouldn't have been higher had Paxil been used. Patients were also on a mood stabilizer of some kind or an antipsychotic. There was no placebo control arm.

Two things leap out at me. A 50 percent chance of having an anti-depressant be ineffective or cause mania is a stunningly high rate as is the 25 percent mania induction figure. A one in four chance of inducing mania in patients for a drug regimen that doesn't work really well doesn't strike me as a risk most informed patients would want to take.

But to each, their own.

By the way, nothing I've written here argues that depression (or bipolar depression) doesn't exist or that people shouldn't take it seriously (they should). It's just pointing out yet again that anti-depressants are a weak technology and simply aren't getting the job done.