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Unnecessary Confusion About Opposite Findings in Two Studies of Tricyclic Treatment of Bipolar Illness

Thomas A. Wehr, MD
Arch Gen Psychiatry. 1990;47(8):787-788. doi:10.1001/archpsyc.1990.01810200095016.
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To the Editor.—  Shapiro and colleagues,1 in the May 1989 issue of the ArCHIVES, conclude, on the basis of their reanalysis of the National Institute of Mental Health (NIMH) Collaborative Study of prophylaxis of bipolar disorder, that "imipramine alone appears to be a poor prophylactic treatment for bipolar disorder." We also found that tricyclic antidepressants were not helpful in the treatment of some bipolar patients in whom they appeared to induce switches into mania and/or rapid cycling between mania and depression.2,3 On the other hand, Shapiro et al conclude that "the combination of lithium and imipramine did not appear to be associated with an appreciably increased risk of recurrence," compared with lithium alone, and that "the combination appeared to be particularly effective in patients with a depressive index episode." They go on to state that the results are "contradictory to [our previous] suggestion that tricyclics induce rapid cycling


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