Psychiatrists have cautioned against the use of antidepressants alone in people with bipolar disorders, saying they could worsen a patient's condition by causing a destabilisation in mood.

Dr Ajeet Singh and Professor Michael Berk, consultant psychiatrists from the University of Melbourne, state in the current edition of Australian Prescriber that the goal of treatment in bipolar disorder is to stabilise mood, and antidepressants may defeat this purpose if they are not taken with other drugs.

"Patients may need an antidepressant, but this must be taken with a mood-stabilising drug. Antidepressants place patients at risk of switching to elevated phases of the disorder and rapid cycling patterns," they say in the article.

Patients should not simply be left on antidepressants long term without review, say the authors, as there is no good evidence of efficacy in the maintenance phase. If symptoms of elevated mood emerge, the patient should have their dose of the antidepressant reduced or stopped.

Dr Singh says that health professionals should consider the diagnosis of bipolar disorder in patients with treatment-resistant or recurrent depression.

The authors also strongly recommend the need for regular review, education, self-monitoring of mood, mood diaries and social-rhythm training to assist with better long-term patient outcomes. Educating patients about lifestyle changes and a close dialogue with relatives and carers is also essential, they say.

"Including family and carers in the management plan is an important aspect of care. Continuity of care, with good communication and rapport between doctor and patient, is particularly important in fostering compliance with treatment," the article states.

For the complete article visit the Australian Prescriber website http://www.australianprescriber.com.

Background

Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published by the National Prescribing Service Limited (NPS), an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing. Australian Prescriber is distributed every two months in hard copy to health professionals, free of charge, and online in full text at http://www.australianprescriber.com.

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Australian Prescriber