Mood switch in bipolar depression: Comparison of adjunctive venlafaxine, bupropion and sertraline.

[Correction Notice: An erratum for this article was reported in Vol 189(6) of British Journal of Psychiatry (see record [rid]2006-22612-029[/rid]). The following declarations of interest have been brought to the Editor's attention since publication of this paper: GlaxoSmithKline--speakers' bureau members: R.M.P., L.L.A., T.S.; consultants/advisory board members: R.M.P., M.A.F., W.A.N., H.G., S.M., P.E.K., T.S.; honoraria recipients: H.G., L.L.A.; grant recipients: M.A.F., W.A.N., P.E.K., T.S. Pfizer--speakers' bureau member: M.A.F.; consultants/ advisory board members: M.A.F., W.A.N., H.G., T.S.; honoraria recipients: W.A.N., H.G.; grant recipients: M.A.F., P.E.K., T.S. Wyeth--consultants/advisory board members: M.A.F., S.M., P.E.K.; honoraria recipients: W.A.N.; grant recipients: W.A.N., S.M., T.S.] BACKGROUND: Few studies have examined the relative risks of switching into hypomania or mania associated with second-generation antidepressant drugs in bipolar depression. AIMS: To examine the relative acute effects of bupropion, sertraline and venlafaxine as adjuncts to mood stabilisers. METHOD: In a 10-week trial, participants receiving out-patient treatment for bipolar disorder (stratified for rapid cycling) were randomly treated with a flexible dose of one of the antidepressants, or their respective matching placebos, as adjuncts to mood stabilisers. RESULTS: A total of 174 adults with bipolar disorder I, II or not otherwise specified, currently in the depressed phase, were included. All three antidepressants were associated with a similar range of acute response (49-53%) and remission (34-41%). There was a significantly increased risk of switches into hypomania or mania in participants treated with venlafaxine compared with bupropion or sertraline. CONCLUSIONS: More caution appears indicated in the use of venlafaxine rather than bupropion or sertraline in the adjunctive treatment of bipolar depression, especially if there is a prior history of rapid cycling. (PsycInfo Database Record (c) 2021 APA, all rights reserved)