The association between antidepressants and rapid cycling in bipolar disorder (BD) is controversial, as the first randomized clinical trial with newer antidepressants showed a three-fold increase in the number of depressive episodes in BD patients compared to those who discontinued antidepressants.

Published in the Journal of Affective Disorders, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study enrolled 68 patients with a confirmed diagnosed of BD types I, II, or NOS who achieved clinical recovery after initial episode of acute BD major depression. Patients were randomized to continue taking an antidepressant plus mood stabilizer, or discontinue antidepressant therapy and continue on mood-stabilizer treatment.

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The authors concluded that clinicians may wish to avoid prescribing antidepressants to patients with BD and a history of rapid cycling in BD to reduce the risk of mania, cycling, and depression.

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