Table 2.

Summary of recent studies examining the risk of manic/hypomanic switch following the use of antidepressants in the treatment of acute bipolar depression.

Increased risk of switch				No increased risk of switch
Study	No. of participants	Drug	Comments	Study	No. of participants	Drug	Comments
Antidepressants as Monotherapy
				Amsterdam and Shults 2005 [13]	34 (BPI = 32, BPII = 2)	Fluoxetine, olanzapine/fluoxetine combination	No Placebo Control
				Parker et al. 2006 [16]	10 BPII	Escitalopram	Small sample size
				Agosti and Stewart 2007 [21]	70 BP II	Imipramine, phenelzine	No valid tool used to assess switch
				Amsterdam and Shults 2008 [17]	83 BPII	Venlafaxine	Compared to Lithium, no placebo control
				McElroy et al. 2010 (EMBOLDEN II) [14]	740 (BPI = 478, BPII = 262)	paroxetine
				Amsterdam and Shults 2010 [15]	148 BPII	Fluoxetine	No placebo control, subsyndromal hypomania in 19.6%
Antidepressants with mood stabilizers
Post et al. 2006 [40]	174	Venlafaxine	15%; no placebo control	Schaffer et al. 2006 [27]	20	Citalopram	Small sample size, no placebo control
Truman et al. 2007 [30]	366 (BPI = 240, BPII = 114)	Paroxetine, bupropion	By self-report only	Fonseca et al. 2006 [28]	20	Escitalopram	Small sample size, no placebo control
Amsterdam and Shults 2010 [15]	148 BPII	Fluoxetine	No placebo control, subsyndromal hypomania in 19.6%	Sachs et al. 2007 [29]	366 (BPI = 240, BPII = 114)	Paroxetine, bupropion
				Perlis et al. 2010 [45]	410	Olanzapine/fluoxetine combination, lamotrigine	Conducted by Lilly Research Laboratories
				Sidor et al. 2011 [32]	1,034 (Meta- Analysis)	Fluoxetine, paroxetine, bupropion, imipramine