Antidepressants for Bipolar Disorder: Pro-Con-Debate

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Activity Date: 04/19/2021

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Session Time and Location

The live session is complete.

Target Audience

This course is designed for pharmacists, nurse practitioners or other health care professionals involved in the comprehensive medication management of psychiatric and/or neurological patients.

Session Summary

There are many nuances to consider when evaluating the risks and benefits of antidepressant use in bipolar disorder (BD). Short-term efficacy of antidepressants for BD remains controversial and risks clinical worsening, especially in mixed states and with rapid-cycling. In this session, Drs. Goldberg and Nierenberg will debate the pros and cons of antidepressant use for BD treatment. Participants will hear evidence on both sides of the debate and gain insight to better equip them to make future treatment recommendations.

Course Requirements

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Upon successful completion, ACPE credit is reported within 24 hours to CPE Monitor although transcripts can be retrieved by participants online in their ACPE Transcript.

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Faculty Information

Joseph F. Goldberg, MD
Andrew Nierenberg, MD

View biographical information

Joseph F. Goldberg, MD
Clinical Professor of Psychiatry
Icahn School of Medicine at Mount Sinai
New York, NY

Joseph F. Goldberg MD, MS is Clinical Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai in New York. Goldberg attended college at the University of Chicago, graduate school in neuroscience at the University of Illinois and Medical School at Northwestern University, followed by a psychiatry residency, chief residency, and psychopharmacology research fellowship at the Payne Whitney Clinic of New York Presbyterian Hospital. While serving on the faculty at Weill-Cornell Medical Center he was site principal investigator for the NIMH STEP-BD program. His research has focused on the clinical psychopharmacology of bipolar and other mood and psychotic disorders. He has received funding from NIMH, NARSAD, the American Foundation for Suicide Prevention, the Stanley Bipolar Research Foundation and industry, and is the author of over 200 peer-reviewed publications and four books, most recently, “Practical Psychopharmacology: Translating Findings From Evidence-Based Trials into Real World Clinical Practice” published by Cambridge University Press in 2020. He serves on the Board of Directors for the American Society of Clinical Psychopharmacology, is a Distinguished Fellow of the American Psychiatric Association, and for many years has been named by Castle Connolly as one of America’s Top Doctors.

Andrew Nierenberg, MD
Director of Dauten Family Center for Bipolar Treatment Innovation
Boston, MA

Andrew Nierenberg, MD, graduated from the Albert Einstein College of Medicine of Yeshiva University, Bronx, NY. After completing his residency in psychiatry at New York University/Bellevue Hospital, he studied clinical epidemiology at Yale University as a Robert Wood Johnson Clinical Scholar. Dr. Nierenberg then joined the faculty at Harvard Medical School, first at McLean Hospital in Belmont, Massachusetts and then at Massachusetts General Hospital, where he is currently Director of the Dauten Family Center for Bipolar Treatment Innovation, Associate Director of the Depression Clinical and Research Program, Director of Training and Education of the MGH Research Institute, Professor of Psychiatry at Harvard Medical School, and the Thomas P. Hackett, MD Endowed Chair in Psychiatry at MGH. He is also Honorary Professor in the School of Medicine, Faculty of Health at Deakin University, Geelong Australia.

Dr. Nierenberg’s primary interests are depression, bipolar depression, and novel treatments. Dr. Nierenberg has published over 475 papers and has been listed in The Best Doctors in America for the treatment of mood and anxiety disorders in every edition since 1994. From 2014 to 2017, he was listed among the World’s Most Influential Scientific Minds by Thompson Reuters in recognition of ranking among the top 1% of researchers for most cited papers in psychiatry worldwide.

Dr. Nierenberg and his colleagues developed an online research infrastructure called the MoodNetwork, a Patient-Powered Research Network (PPRN) that is part of the Patient-Centered Outcomes Research Institute (PCORI). The main aim of the MoodNetwork is to bring together patients, caregivers, and other stakeholders who are affected by mood disorders (i.e., Bipolar Disorder and Unipolar Depression) to form a cohort using patient-reported outcomes and electronical medical records as a national infrastructure for future studies and to participate in comparative-effectiveness studies. Additionally, he is currently the principal investigator for three Patient Centered Outcomes Research Institute (PCORI) projects that use MoodNetwork at a platform for research.

Learning Objectives

Outline the benefits and risks of antidepressant utilization in the treatment of bipolar disorder.
Identify the risk of antidepressants to provoke treatment emergent affective switches in bipolar disorder and understand patient specific clinical characteristics that may influence antidepressant treatment outcomes.
Describe data supporting or refuting the safety and efficacy of antidepressant use in bipolar disorder based on key meta-analyses.
Discuss the strengths and limitations in the evidence base for antidepressants for bipolar disorder.

Continuing Education Credit and Disclosures

Activity Date: 04/19/2021
ACPE Contact Hours: 1
ACPE Number: 0284-0000-21-002-L01-P (Knowledge)
Nursing Credit Reminder: Note that ACPE credit is accepted for ANCC Certification Renewal and AANPCB advanced practice provider content. For specific questions related to your organization's acceptance of ACPE continuing education units, please contact your organization directly.

ACPE The College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

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View planning committee disclosures

2021 Program Committee

Shari N. Allen, PharmD, BCPP
Assistant Professor
PCOM-SOP
Suwanee, GA
No Relevant Financial Relationships to Disclose

Jolene R. Bostwick, PharmD, BCPP, BCPS

Program Administrative Chair

Assistant Dean for Co-Curriculum and Professional Development & Clinical Professor
University of Michigan College of Pharmacy
Ann Arbor, MI
No Relevant Financial Relationships to Disclose

Bridget Bradley, PharmD, BCPP
Associate Professor
Pacific University School of Pharmacy
Hillsboro, OR
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: PSAP May 2021, Neurology and Psychiatry Book
Educational Grants, Research Grants or Contracts: NACDS Community Pharmacy Residency Grant

Lauren M. Brown, PharmD, BCPP
Clinical Pharmacy Specialist, Psychiatry
South Texas Veterans Health Care System
San Antonio, TX
No Relevant Financial Relationships to Disclose

Austin R. Campbell, PharmD, BCPP
Clinical Pharmacy Specialist - Psychiatry
University of Missouri Health Care
Columbia, MO
Financial Interests: Up To Date Contributor "Pharmacotherapy for schizophrenia: Long-acting injectable antipsychotic drugs"
Non-Financial Interests: Extension for Community Healthcare Outcomes, Show-Me ECHO Project

Chelsea N. Carr, PharmD, BCPP
Advanced Practice Pharmacist - Psychiatry
University of Maryland - Spring Grove Hospital Center
Catonsville, MD
No Relevant Financial Relationships to Disclose

Jordan Cooler, PharmD, BCPP
Clinical Assistant Professor
University of South Carolina College of Pharmacy
Columbia, SC
No Relevant Financial Relationships to Disclose

Amber R. Douglass, PharmD, BCPS, BCPP
Clinical Pharmacy Specialist - Mental Health
VA Tennessee Valley Healthcare System
Murfreesboro, TN
No Relevant Financial Relationships to Disclose

Kristen N. Gardner, PharmD, BCPP

Program Committee Chair

Clinical Pharmacy Specialist - Behavioral Health
Kaiser Permanente Colorado
Denver, CO
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Biostrategies - one time consultant re:LAIAs

Robert J. Haight, PharmD, BCPP
Clinical Pharmacist | Forensic Services
Saint Peter Regional Treatment Center (SPRTC), Minnesota Department of Human Services
Saint Peter, MN
No Relevant Financial Relationships to Disclose

Suzanne C. Harris, PharmD, BCPP
Clinical Assistant Professor/UNC Hospitals Region Experiential Director/Clinical Pharmacist Practitioner
UNC Eshelman School of Pharmacy
Chapel Hill, NC
Educational Grants, Research Grants or Contracts: North Carolina AHEC Campus Innovations Grants

Kayla D. Johnson, PharmD, BCPS, BCPP
Vanderbilt Psychiatric Hospital
Spring Hill, TN
No Relevant Financial Relationships to Disclose

Erin D. Knox, PharmD, BCPP
Pharmacy Education Specialist
UC Irvine Health
Orange, CA
No Relevant Financial Relationships to Disclose

Marketa Marvanova, PharmD, PhD, BCGP, BCPP, FASCP
Dean and Professor
University of Montana, Skaggs School of Pharmacy
Missoula, MT
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Editorial Board member: Continuum: Lifelong Learning in Neurology, consultant for Lexicomp as a clinical specialist in neurology and psychiatry
Educational Grants, Research Grants or Contracts: AACP/NABP: District V grant, Dakota Medical Foundation

Melissa Mitchell, PharmD, BCGP, BCPP, BCPS
Senior Clinical Pharmacist
RUHS MC
Moreno Valley , CA
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Neurocrine Speakers Bureau - Ingrezza, Janssen Speakers Bureau - Spravato

Thea R. Moore, PharmD, BCPP
Associate Professor
University of South Florida
Tampa, FL
Educational Grants, Research Grants or Contracts: Agency for Health Care Administration

Kristen Neumeister, PharmD, BCPP
Clinical Pharmacist- Mental Health
John Peter Smith Hospital
Fort Worth, TX
No Relevant Financial Relationships to Disclose

Melissa C. Palmer, PharmD, BCPP, BCPS
Clinical Assistant Professor
University of Missouri-Kansas City School of Pharmacy
Kansas City, MO
No Relevant Financial Relationships to Disclose

Lindsey Peters, PharmD, BCPS
Assistant Professor of Pharmacy Practice
Ohio Northern University
Ada, OH
No Relevant Financial Relationships to Disclose

Kristina Reinstatler, PharmD, BCPP, MBA
Clinical Pharmacy Specialist
UC Health University of Cincinnati Medical Center
Cincinnati, OH
No Relevant Financial Relationships to Disclose

Michael D. Shuman, PharmD, BCPP
Staff Pharmacist
Central State Hospital
Louisville, KY
No Relevant Financial Relationships to Disclose

Sheryl Thedford, PharmD, PhD, BCPS, BCPP
Clinical Psychiatric Pharmacist
University of Maryland, Spring Grove Hospital Center
Catonsville, MD
No Relevant Financial Relationships to Disclose

Taylor A. Thomas, PharmD, BCPP
Clinical Pharmacy Specialist- Mental Health
VA Northern Indiana Health Care System
Fort Wayne, IN
No Relevant Financial Relationships to Disclose

All relevant relationships have been mitigated.

View disclaimer and disclosure of off-label use

Off-Label Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA (see faculty information). The opinions expressed in the educational activity do not necessarily represent the views of AAPP and any educational partners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Presentation-Specific Disclosure: (Goldberg) My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: antidepressants for bipolar disorder; lurasidone for major depressive disorder with mixed features; (Nierenberg) My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: antidepressants for bipolar disorder; lurasidone for major depressive disorder with mixed features

View fair balance and integrity statement

It is the policy of AAPP to ensure independence, balance, objectivity, scientific rigor, and integrity in continuing education activities. Those involved in the development of this continuing education activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education activity. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the reader is advised to check the manufacturer’s package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.

Fair balance is achieved through ongoing and thorough review of all materials produced by faculty, and all educational and advertising materials produced by supporting organizations, prior to educational offerings. Approval of credit for this continuing education activity does not imply endorsement by AAPP for any product or manufacturer identified.

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