Randomised controlled trials (RCTs) that evaluated the use of antidepressants in the treatment of acute bipolar depression, and assessed the risk of antidepressant-induced manic switch, were eligible for inclusion. In addition, non-RCTs that evaluated the impact of antidepressant discontinuation after acute antidepressant response were eligible for inclusion.
Most of the included studies evaluated participants with bipolar I and/or bipolar II disorder; some studies did not specify the type of bipolar disorder. The main antidepressant drugs evaluated were paroxetine, bupropion, fluoxetine, and imipramine; other tricyclic antidepressants, monoamine oxidase inhibitors and other antidepressants were also evaluated. Comparison groups included placebo and/or other agents (e.g. risperidone, lithium/divalproex). Most of the studies included concurrent mood stabilisers. Where reported, length of study duration varied from four to 26 weeks.
The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.