Int’l Task Force Doesn’t Endorse Antidepressants for Bipolar


Noting a “striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar,” a large international task force, publishing in the American Journal of Psychiatry, concluded that “because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants.”

Abstract →

Pacchiarotti, I., Bond, D., Baldessarini, R., Nolen, W., et al.; The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders. American Journal of Psychiatry. September 13, 2013

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. I’d like my psychiatrist to acknowledge that antidepressants actually caused my bipolar disorder years ago. The most I’ve ever gotten him to admit is that antidepressants can sometimes cause “mania.” This statement is misleading, at best, and makes it sound like antidepressants merely have side effects (as do all drugs, of course). The truth is if you’ve got depression and you develop mania, then you’ve got bipolar disorder.

    Upon a toxic reaction to a drug, a rational physician would at least entertain the thought that the patient should immediately be taken off the drug, to see if the new adverse situation resolved. Not a psychiatrist, though. Oh, no! The antidepressant must have “triggered” the underlying bipolar disorder. More drugs required: mood stabilizers, antipsychotics. I’m long past considering a psychiatrist a “rational physician.”

    I’d like to see some effort towards making an educated guess as to how many “bipolars” are actually just mis-medicated “depressives.” That’s not a very sexy area of study and Big Pharma wouldn’t be interested, I’m quite sure.

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    • I guarantee, the numbers are huge. I see it every day in the foster care population. And it’s not just antidepressants. A lot of kids start on stimulants, get aggressive, lose sleep, may even get a bit delusional, and whack! They’re bipolar and get antipsychotics. Which is really bizarre, because stimulants increase dopamine while antipsychotics reduce it. So if you think the kids’ got too much dopamine going on, why not stop increasing it with drug A instead of decreasing it with drug B? But that would be rational, wouldn’t it.

      The bipolar epidemic is only partly due to Joseph Biedermann’s arbitrary retooling of the criteria for “juvenile bipolar disorder.” I believe the bulk of it is fueled by adverse reactions to “antidepressants” and stimulant drugs.

      —- steve

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  2. Steve – Right about foster care, but it’s even worse than that. Bipolar is the latest fad, and foster kids are labelled bipolar even before they’ve been exposed to psych drugs. The willy nilly use of this bogus label is so extreme that it seems any kid who is capable of having more than one mood is likely to be swept up in the bipolar pile. If he (almost always a “he”) is sometimes sad (which anyone put in foster care is likely to be), and if he is occasionally aggressive (which kids traumatized by their environment often are) – he is at risk for being called “bipolar.” Works great if your goal is to numb him out and make him easier to “manage” (i.e., “stable”); it isn’t so good if you’re interested in who he actually is, what he’s going through and how he can live the full life he deserves.

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    • Too true, Peter. It seems that foster kids are somehow supposed to be happy that we’ve removed them from their awful parents, and any manifestations of grief, confusion, anxiety or anger at us for “helping” them in ways they did not ask for are signs of their personal dysfunction. Sadly, the DSM invites and encourages this kind of “diagnosis” without any consideration for context. And of course, it happens just the same with adults, although the kids have less power and I think need even more protection. It’s such a horrific scam, it’s hard to even know where to begin to unravel it. But I think it starts with challenging the concept that we should all be “well adjusted” regardless of what happens to us. Which in the case of foster kids is patently ridiculous, yet it happens every day.

      —- Steve

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