15 In this trial, patients with BP-I or II were randomly assigned to treatment with bupropion, paroxetine, or placebo added to an FDAapproved antimanic agent. The trial employed an equipoise-stratified randomization design; thus, psychiatrists could choose from three strata, (placebo vs bupropion, placebo vs paroxetine, or placebo vs either antidepressant) to allow research participation, even if the patient held a clear preference for one antidepressant versus another. A total of 366 patients enrolled in the study and were randomized to receive either a mood stabilizer plus

placebo (N=187) or a mood stabilizer plus an antidepressant. (N=179). As opposed to Inhibitors,research,lifescience,medical simple measurements of response, durable recovery was uniquely chosen as the primary outcome measure, defined as a state of euthymia for 8 consecutive weeks. Secondary outcomes included traditional rates of response based on a ≥ 50% improvement

on the Structured Clinical Interview for DSM-IV continuous symptom subscale for depression. In the end, rates of durable Inhibitors,research,lifescience,medical recovery were similar between the antidepressant (23.5%) and placebo (27.3%) groups (P=0.4). Response rates also did not differ between groups, and BP-I subjects Inhibitors,research,lifescience,medical were as likely to respond (25.4%) as were BP-II subjects (20.4%). Adjunctive antidepressant administration was not found to confer a greater benefit than mood-stabilizer monotherapy in the treatment, of bipolar depression. Additionally, antidepressants were not associated with an increase in cycling between the depressive and manic poles. In summary, the study found neither an advantage nor disadvantage associated with use of the antidepressants bupropion or paroxetine. Conventional mood stabilizers

Inhibitors,research,lifescience,medical and atypical antipsychotics lithium Although lithium is the oldest, agent Inhibitors,research,lifescience,medical studied for the acute treatment of bipolar depression, it remains a viable and underutilized option with established efficacy in various trial selleck inhibitor designs and clinical experience. Zornberg and Pope,16 in a comprehensive review of controlled investigations of lithium, identified eight, studies that demonstrated lithium to be more effective than placebo in the treatment of acute bipolar depression. Nevertheless, most of the constituent studies in their analysis were older investigations (ie, published ADP ribosylation factor prior to 1978), or limited by several methodological shortcomings. For instance, our search strategy was unable to identify any moderately sized studies of lithium for the acute treatment of bipolar depression. Furthermore, early trials employed crossover as opposed to parallel designs introducing the possibility for carryover effects. The abrupt, discontinuation of lithium may also have biased efficacy assessments, as acute withdrawal of lithium leads to, and hastens, a high probability of relapse.