" The study in the New England Journal of Medicine narrows the already limited number of treatments for bipolar disorder, which affects 5.7 million adults in the U.S., experts said."

" "A new generation of drugs is needed," said Dr. Thomas R. Insel, director of the National Institutes of Mental Health. "It is clear from this data that antidepressants are not the answer.""

" Still, some doctors said antidepressants would continue to have a role because there are so few options, and the drugs seem to alleviate other distressing symptoms that often accompany the complex disorder."

" Many people no longer respond to a mood stabilizer alone "and adding an antidepressant markedly improves them," said Dr. Lori Altshuler, professor of psychiatry at UCLA, who was not involved in the study."

" But Altshuler, who has consulted for companies that market drugs for psychological disorders, said the study very clearly demonstrated that patients should first try a mood stabilizer, which can also have antidepressant effects."

" People with bipolar disorder experience severe mood swings between depression and mania, a state marked by an excess of energy and restlessness. For most patients, depressive episodes are three times more common and longer-lasting than those of mania. Symptoms of the disorder can interfere with daily activities, and severe cases carry a risk of suicide."

" Standard treatment consists of mood stabilizers such as lithium, valproate and carbamazepine. Antidepressants are often added to control severe depressive swings, despite concerns the drugs may trigger a switch to a manic episode."

" Researchers estimated that 50% to 70% of people with bipolar disorder take antidepressants, although the Food and Drug Administration has approved none of the drugs as a treatment for the disorder."

" The study, part of the NIH's $27-million Systematic Treatment Enhancement Program for Bipolar Disorder, or STEP-BD, set out to determine whether the common antidepressants, Wellbutrin and Paxil, would enhance the benefits of mood-stabilizer drugs. The study was also designed to find out if the antidepressants would
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