Priority 29 from the Bipolar PSP

UNCERTAINTY:Can medication such as antidepressants trigger the onset of bipolar or worsen its course? (JLA PSP Priority 29)
Overall ranking	29
JLA question ID	0041/29
Explanatory note	Not available for this PSP.
Evidence	Ghaemi SN, Wingo AP, Filkowski MA, Baldessarini RJ. Long-term antidepressant treatment in bipolar disorder: meta-analyses of benefits and risks. Acta Psychiatrica Scandinavica. 2008;118:347-56. [Comment: Highlights poor generalizability of treatments; 8 years old] Gijsman HJ, Geddes JR, Rendell JM, Nolen WA, Goodwin GM. Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. American Journal of Psychiatry. 2004;161:1537-47. [Comment: 12 years old] Tondo L, Vazquez G, Baldessarini R. Mania associated with antidepressant treatment: comprehensive meta-analytic review. Acta Psychiatrica Scandinavica. 2010;121:404-14. [Comment: 6 years old] Bond DJ, Noronha MM, Kauer-Sant’anna M, Lam RW, Yatham LN. Antidepressant-associated mood elevations in bipolar II disorder compared with bipolar I disorder and major depressive disorder: a systematic review and meta-analysis. J Clin Psychiatry 2008; 69: 1589–1601. [Comment: 8 years old]
Health Research Classification System category	Mental Health

Extra information provided by this PSP
Original uncertainty examples	For full examples, see Category ID T10 on spreadsheet. Do my Adhd meds (Elvanse), cause additional bipolar mood swings? ~ What are the complications with use of antidepressants in bipolar I? Are they as 'bad' as the literature suggests? And if I have to resort to using antidepressants, what is the best advice for the patient/team/family? ~ Does exposure to anti depressant medication explain the astronomic rise in bipolar disorder since its introduction. Whittiker et al suggest this to be the case. ~ apparently bi-polar is a chemical imbalance in the brain. May it be caused by reactions to previously taken medication? ~ Effects of anti-depressants and other prescribed medications in adolescence on development of Bipolar? ~ Can taking Adderal cause bipolar? ~ Why are medications advertised for depression, such as abilify, so catastrophic for bipolar patients and why isnt bipolar listed in the do not take this if you are: section of the commercials.
Submitted by	Patients x 50 ~ Carers x 18 ~ Health Professionals x 8 ~ others x 4

Extra information provided by this PSP

Original uncertainty examples

For full examples, see Category ID T10 on spreadsheet. Do my Adhd meds (Elvanse), cause additional bipolar mood swings? ~ What are the complications with use of antidepressants in bipolar I? Are they as 'bad' as the literature suggests? And if I have to resort to using antidepressants, what is the best advice for the patient/team/family? ~ Does exposure to anti depressant medication explain the astronomic rise in bipolar disorder since its introduction. Whittiker et al suggest this to be the case. ~ apparently bi-polar is a chemical imbalance in the brain. May it be caused by reactions to previously taken medication? ~ Effects of anti-depressants and other prescribed medications in adolescence on development of Bipolar? ~ Can taking Adderal cause bipolar? ~ Why are medications advertised for depression, such as abilify, so catastrophic for bipolar patients and why isnt bipolar listed in the do not take this if you are: section of the commercials.

Submitted by

Patients x 50 ~ Carers x 18 ~ Health Professionals x 8 ~ others x 4

PSP information
PSP unique ID	0041
PSP name	Bipolar
Total number of uncertainties identified by this PSP.	363 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	14 June 2016