Pros and Cons: The Usefulness of Antidepressants in Bipolar Depressive Episodes

Bipolar depression differs from unipolar depression in clinical features, pharmacological response, clinical course, and prognosis. Accordingly, the use of antidepressants—considered a standard pharmacological treatment for unipolar depression—remains a matter of ongoing debate in the management of bipolar depression. Skeptical perspectives emphasize that antidepressants may provide limited additional benefit, exacerbate symptoms, or increase the risk of rapid cycling and suicidality. In contrast, proponents argue that antidepressants can contribute meaningfully to symptom improvement in selected cases. This review examines both the skeptical and supportive viewpoints on antidepressant use in bipolar depression and summarizes current recommendations from Korean and major international treatment guidelines. It aims to offer practical insights for clinicians engaged in the management of patients with bipolar depression.