Do not use antidepressants in patients with bipolar disorder

There are exceptions, but as the title of this editor's note suggests, clinicians should re-examine use of antidepressants in patients with bipolar disorder. This entails differentiating two types of depression, which is a difficult task for primary care physicians (PCPs). In a recent issue of the New England Journal of Medicine, a study - which any clinician who treats depressed patients should read or at least understand - reported the results of a controlled trial evaluating the effectiveness of antidepressants as short-term treatment of episodes of major depression in patients with bipolar disorder. 1 The study was part of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), a collaboration sponsored by the National Institute of Mental Health and designed to evaluate the effectiveness of treatments for bipolar disorder and provide results that are generalizable to routine clinical practice.