Abstract
I read the debate by Gomes et al.1 with great interest, and I agree with their concerns regarding the persistent use of non-recommended and contraindicated interventions in bipolar disorders. Nonetheless, I cannot agree with their salient example of treating bipolar depression with antidepressant monotherapy. I obviously understand the risk of antidepressant use in the treatment of bipolar depression, as it has been associated with treatment-emergent mania, mood destabilization, dysphoria induction, and suicidal tendencies.2 As shown by Gomes et al.'s Table 11 showing non-recommended treatments for the treatment of bipolar depression, according to the 2018 CANMAT/ISBD guidelines3 for the treatment of bipolar depression, antidepressant monotherapy is regarded as a non-recommended treatment. However, strictly speaking, this holds true for bipolar I disorder, and not for bipolar II disorder. According to the guidelines,3 venlafaxine monotherapy and sertraline monotherapy wererecommended as second-line treatments, and fluoxetine monotherapywasrecommended asathird-line treatment forpatients withbipolar II depression. In this context, I recently published a review4 that focused on antidepressant monotherapy in bipolar depression.
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