Dr. Bauer Replies

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Sir: Dr. Benazzi’s scholarly letter regarding our recent report that antidepressants do not increase suicidality in individuals with bipolar disorder amplifies a point that we reported but did not extensively discuss: that manic symptoms are associated with increased rates of suicidality. Our finding that such symptoms do not mediate antidepressant effects does not mean that these symptoms are not of impact in their own right. On the contrary, manic symptoms are common during bipolar depressive episodes, as Dr. Benazzi’s extensive review points out.’ ‹