The international society for bipolar disorders (ISBD) task force report on antidepressant use in bipolar diosrders

Objective:
The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders.

Method:  
An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder.

Results:  
There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder.

Conclusions:
Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.

Sharpening the focus of force field analysis

The purpose is to explore the inherent complexity of Kurt Lewin's force field theory through applied analysis of organizational case examples and related methods. The methodology applies a range of tools from the consultancy research domain, including force field analysis of complex organizational scenarios, and applies bricolage and corroboration to emerging discoveries from semi-structured interviews, author experience, critical reflection and literature survey. Findings are that linear representation of internal and external forces in organizational applications of field theory does not fully explain the paradox of inverse vectors in the forces of change. The force field is not an impermeable thing; instead, it morphs. Examples of the inverse principle and its effects are detailed and extended in this analysis. The implications of the research are that force field analysis and related change processes promoted in organizational change literature run the risk of missing key complexities. The inclusion of the inverse principle can provide enhanced, holistic understanding of the prevailing forces for change. The augmentation of the early work of Kurt Lewin, and extension of previous analyses of his legacy in the Journal of Change Management and elsewhere, provide, in this article, change analysis insights that align well with current organizational environments.