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The conundrum of antidepressant use in bipolar disorder

Molecular Psychiatry volume 28, pages 972–973 (2023)Cite this article

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In this issue of Molecular Psychiatry, Gardea-Resendez and colleagues [1] set forth to assess whether antidepressants that increase mitochondrial activity may elicit mania in bipolar disorder (BD). BD afflicts an estimated 2.8% of the United States adult population (5.6 million persons), at an estimated total (75% indirect and 25% direct) societal cost of $195 billion [2]. Of all mood disorders, BD has the highest likelihood (89%) of severe impairment, an estimated suicide risk of 17%, and is the sixth-leading cause of worldwide disability [2]. In the United States, BD is expected to decrease life expectancy by 7–10 years [3].

In the treatment of BD, mania and hypomania are generally the main focus, but depression is the more prominent mood state. Traditionally, mood stabilizers have been used as the first line of treatment for BD, but antidepressants are often used to prevent relapses. About 20% of Canadians with BD are treated with antidepressants, while only 8% are treated with mood stabilizers. In contrast, in the United States, 50% are given antidepressants, and 25% are treated mood stabilizers [4]. However, many BD patients do not respond well to antidepressant monotherapy, whereas others (particularly those with a high degree of hyper- or hypomania) may experience significant adverse effects, including exacerbation of mania (referred to as “treatment-emergent mania”) [5]. Overall, compared with mood stabilizer monotherapy, antidepressant monotherapy significantly increases the risk of an affective switch (cycling), with no improved prophylaxis of new depressive episodes [5, 6]. In this regard, identifying and tailoring treatment based on modulators of response is essential.

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References

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Funding

The research funding support from University of Texas Health Science Center at Houston, the Louis A. Faillace, MD Endowment Funds and Translational Psychiatry Program to GS and JQ are acknowledged. Translational Psychiatry Program (USA) is funded by the Department of Psychiatry and Behavioral Sciences, McGovern Medical School at UTHealth and Linda Gail Behavioral Health Research Fund. Center of Excellence on Mood Disorders (USA) is funded by the Pat Rutherford Jr Chair in Psychiatry, John S. Dunn Foundation and Anne and Don Fizer Foundation Endowment for Depression Research. Translational Psychiatry Laboratory (Brazil) is funded by grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Fundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarina (FAPESC), Instituto Cérebro e Mente and University of Southern Santa Catarina (UNESC).

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Authors and Affiliations

  1. Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA

    Giselli Scaini & João Quevedo

  2. Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA

    Giselli Scaini & João Quevedo

  3. Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA

    Giselli Scaini & João Quevedo

  4. Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil

    João Quevedo

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  1. Giselli Scaini
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GS drafted the first version of this article, which was critically revised by JQ. In total, both authors contributed equally to this work.

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Correspondence to Giselli Scaini.

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Scaini, G., Quevedo, J. The conundrum of antidepressant use in bipolar disorder. Mol Psychiatry 28, 972–973 (2023). https://doi.org/10.1038/s41380-022-01930-y

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