Antidepressants in bipolar disorder: caveats in interpreting and applying the findings of Altshuler et al.

To the Editor: I am writing with concerns about the interpretation and application of the important findings of the recent study reported by Altshuler et al. In my work at a university-affiliated teaching hospital and in other settings over the past 5 years, I have seen near-universal (well in excess of 80%) prescribing of antidepressants to patients with bipolar disorder. In many cases, these patients have not had a trial or trials of traditional mood stabilizers (lithium, divalproex, or carbamazepine) in the absence of antidepressants. A recent study showed antidepressants to be the first-choice agent for bipolar patients twice as often as mood stabilizers.