ABSTRACT
A switch from severe depression to severe mania is arguably one of the most impressive courses of illness that a patient and his or her psychiatrist can encounter. Many such patients will have been on antidepressants at the time of this switch; in these patients there is always the question and even an ongoing debate about whether the antidepressant has caused the switch, or whether the natural course of the illness has contributed to this switch. As a consequence of this debate however, over the past decades, the place of antidepressants in the treatment of bipolar disorder has switched almost as dramatically from first choice (even in maintenance treatment) to no place at all, in some guidelines not even in the acute treatment of bipolar depression.
