After 30 years researching antidepressants in bipolar disorder, Dr. Nassir Ghaemi challenges the mainstream consensus on their use. Drawing on his own NIMH-funded research and a recent Instagram debate with fellow bipolar expert Roger McIntyre, he explains why antidepressant monotherapy fails in bipolar depression regardless of subtype, why most clinicians overlook critical factors like mixed states and rapid cycling, and what the evidence actually shows about long-term outcomes. A candid, data-driven episode for clinicians ready to question conventional prescribing practices. Join the discussion live at https://psychiatryletter.com/clinical-dialogues-2026-live/