The utility of antidepressants for depression in bipolar disorder remains highly contentious. Early reports that antidepressants can induce mania or hasten affective recurrences has led many clinicians to eschew them almost entirely, while others perceive them as "necessary evils" in light of the tremendous depressive illness burden associated with bipolar disorder. The past 10 years have generated important empirical findings that help shed light of the risks, benefits, and pharmacologic niche for antidepressants in bipolar depression. Key points from contemporary research include observations that noradrenergic antidepressants may pose higher risks for mood destabilization than other antidepressants; subgroups of individuals with bipolar disorder may be predisposed to antidepressant-associated mania; mood stabilizing agents may not routinely prevent antidepressant-induced mania; and some mood stabilizing agents themselves may possess antidepressant properties comparable or even superior to the antidepressant effects of traditional antidepressants. Defining antidepressant-associated mania is itself likely a matter of degree, and often difficult to differentiate from the natural course of an inherently cyclical illness. This presentation will formulate practical recommendations for clinicians on the risks and benefits of antidepressants in bipolar disorder. The aggregate of information from clinical trials will be discussed in the context of treating "real world" patients, in order to identify a patient-specific, tailored approach for treating bipolar depression safely and effectively.