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Conversely, the most recent systematic review and network meta-analysis from 2025 by Oliva et al [23], including 13 RCTs and 1,362 patients with bipolar depression, concluded that: although some evidence of increased risk of switching to mania was observed, no antidepressant was associated with a significantly higher risk of switch to mania compared to placebo

However, the drawbacks include the requirement of a blood draw, which may cause discomfort or bruising