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Activity Dates: 05/01/2011 - 05/01/2014

This course is closed. Please look for other available products in CPNP University.

Target Audience

If you are a pharmacist, nurse practitioner or other healthcare professional involved in the comprehensive medication management of psychiatric and/or neurological patients, we invite you to participate in this online course.

Session Summary

The safety and efficacy of antidepressants for patients with bipolar disorder continues to remain a source of tremendous controversy.  Initial reports of antidepressant-induced mania or hypomania led to marked concern among practitioners that antidepressants were highly likely to destabilize mood and worsen the course of illness in most people with bipolar disorder.  More recent investigations indicate that the potential for antidepressants to cause mania or hypomania is a rarer phenomenon than originally thought, occurring in about 10-15% of bipolar disorder patients.  Moreover, studies from the past two decades identify patient-specific risk factors for the emergence of antidepressant-associated mania or hypomania, suggesting its potential significance as an illness endophenotype.  Clinical studies suggest that the risk for mood destabilization from antidepressants appears higher in individuals with bipolar I (rather than bipolar II) disorder, as well as those with concomitant manic/hypomanic symptoms during depressive illness phases, recent manic or hypomanic episodes, comorbid alcohol or drug abuse, and past histories of antidepressant-induced mood destabilization.  Furthermore, risk may be somewhat higher with noradrenergic antidepressants (such as tricyclics or serotonin/norepinephrine reuptake inhibitors) than with purely serotonergic or primarily dopaminergic agents.  Co-therapy with antimanic drugs such as lithium may not reliably mitigate the risk for antidepressant-induced mania or hypomania.

Contrary to most practice guidelines, randomized trials suggest that lack of efficacy poses a greater and more common risk than mood destabilization when using antidepressants for bipolar depression.  Only the combination of fluoxetine with olanzapine has demonstrated better antidepressant efficacy in bipolar depression trials than mood stabilizers alone.  Controlled trials point to the efficacy and utility of novel pharmacotherapies as offering greater value than traditional antidepressants for the treatment of bipolar depression, including certain second generation antipsychotics (e.g., quetiapine and olanzapine-fluoxetine combination), the stimulants modafinil and armodafinil, the dopamine agonist pramipexole, lamotrigine plus lithium, and intravenous ketamine.

Course Requirements

You will proceed through the following steps to satisfactorily complete this course:

  • Review the full content of the activity and reflect upon its teachings.
  • Complete the post-test at the end of the activity no later than the closing activity date. (login first)
  • Complete the evaluation at the end of the activity. (login first)
  • Receive a passing grade (60%).
  • Provide the necessary details in your profile to ensure correct reporting by CPNP to CPE Monitor. (login first)

This course is provided online at cpnp.org and consists of the speaker audio and slides. A PDF file of the slides is also provided and access is available to participants indefinitely although ACPE credit is available only through the course expiration date.

Participants in this course must complete an examination and achieve a score of 60% or greater. Successful completion of the course also requires the completion of a course evaluation. ACPE statements of credit can be retrieved by participants online at cpnp.org immediately upon successful completion of the course.

Faculty Information and Disclosures

Learning Objectives

  1. Analyze evidence from controlled trials regarding efficacy of antidepressants in the treatment of acute bipolar depression.
  2. Evaluate factors that increase the risk of antidepressant-induced mania.
  3. Assess appropriateness of antidepressant use in bipolar depression based on patient-specific factors.
  4. Formulate a treatment plan for a patient with bipolar depression.

Continuing Education Credit and Disclosures

Activity Dates: 05/01/2011 - 05/01/2014
ACPE Contact Hours: 1.0
ACPE Number: 0284-9999-11-002-H01-P (Application)
Nursing Credit Reminder: Note that ACPE credit is accepted for certification renewal.

ACPEThe College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This self-study course provides 1.0 contact hours (0.10 CEUs) of knowledge-based continuing education credit from CPNP approved programming. The ACPE universal program number assigned to this course is 0284-0999-11-002-H01-P (1.0 contact hours).

ACPE approved contact hours are accepted for ANCC Certification Renewal (see pages 5 and 6): At least 50% (37.5 hours) of your 75 continuing education hours must be formally approved continuing education hours. Formally approved continuing education hours meet one or more of the criteria listed below:

  1. Continuing nursing education (CNE) approved for nursing contact hours by an accredited provider or approver of nursing continuing education
  2. Continuing medical education (CME) approved for CME hours
  3. Sponsored by organizations, agencies, or educational institutions accredited or approved by the American Nurses Credentialing Center (ANCC) or the Accreditation Council for Continuing Medical Education (ACCME) or the Accreditation Council for Pharmacy Education (ACPE) or the Commission on Dietetic Registration

Grant Support

Supported by an educational grant from Janssen, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs, LLC and Lilly USA, LLC.

This programming was supported in part by grants from Bristol-Myers Squibb, Cyberonics, Merk and Sunovion.

Annual Meeting Grant Supporter

BCPP Recertification Grant Supporter


Supported by an educational grant from Janssen, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs, LLC.


This activity is supported by an educational grant from Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com.