Antidepressants in bipolar depression: when less is more
Bibliographic record
Abstract
A 54-year-old woman with bipolar disorder was referred for a consultation for refractory depression. She has a family history of bipolar disorder. The initial course of her illness is described as clearly episodic, with full recovery between minor depressive and hypomanic episodes that she had been experiencing since her teens. At the age of 26, she developed postpartum depression and was treated with a tricyclic antidepressant. Later, after a manic episode, she was diagnosed with bipolar disorder and treated with a combination of lithium (plasma levels 0.7–0.9 mmol/L) and various antidepressants (i.e., all available selective serotonin reuptake inhibitors, bupropion, doxepine, amitriptyline and venlafaxine). In addition, she had trials of carbamazepine, sodium divalproex, lamotrigine and several neuroleptics. Her course of illness gradually became more chronic. For the last 10 years, she has been mostly depressed with intermittent improvements. At the time of consultation, she was severely depressed, crying, with poor concentration and hypnagogic hallucinations; her medications were lithium carbonate, citalopram, lorazepam, L-THYROXINE AND ESTRADIOL.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".