Antidepressants in Bipolar Depression: Still Controversial After All These Years

The use of antidepressants in the treatment of bipolar disorder (BD) has been one of the more enduring controversies in the field. Antidepres-sants continue to be one of the most widely used classes of psychotropic agents in BD and are still prominent-ly featured in most treatment guide-lines, despite the limited and incon-sistent evidence supporting their safety and efficacy in the treatment and prevention of episodes of bipolar 1 depression. Herein, the authors re-view the clinical and meta-analytical evidence on the effi cacy and safety of antidepressants in BD types 1 and 2. Clinicians should be aware of the potential risks and benefits of anti-depressants for patients with BD, as well as the scenarios and patients' characteristics that can affect treat-ment outcomes. [Psychiatr Ann. 2023;53(2):63-67.]