background The literature gives caution for the induction of a (hypo)mania owing to the use of antidepressants in bipolar disorder.
aim To examine (1) the evidence for the assumption that the use of antidepressants by patients with a bipolar disorder increases the risk of (hypo)mania; (2) the underlying risk factors; and (3) the extent to which a mood stabilizer may be protective.
method A systematic review was conducted searching Pubmed for the period of 1960-2000, Embase from 1987-2000 and the Cochrane Library for the period of 1940-2000 using as key words 'antidepressant', combined with 'mania or hypomania' and 'induction or switch'. Additional publications were obtained by hand searching the references of the articles found.
results Only six relevant studies could be included. All of them had methodological shortcomings. Overall, there appears to be hardly any evidence that the use of antidepressants in bipolar disorder increases the risk of (hypo)mania or mania. However, certain patients among whom women, patients with a bipolar-i disorder and patients who had a mania as a last episode, may be vulnerable. Mood stabilizers are possibly protective.
conclusion There is a great need for adequate studies of sufficient size providing evidence on the influence of antidepressants on the induction of (hypo)mania in bipolar disorder. For the time being, treatment of bipolar depression may best be based on the results of the life chart of the individual patient.