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Antidepressants for Bipolar Disorder

Many people assume that antidepressants can help relieve depression and boost mood in those with bipolar disorder, although research suggests that antidepressants may be less effective for treating depression in people with bipolar than than other types of depression. It typically takes three to four weeks for most people to respond to the treatment. Sometimes a doctor will try several different antidepressants and doses before finding one that works for a patient.

There are many different types of antidepressants used to treat depression among people with bipolar disorder, although many of the existing studies of their efficacy are based solely on people with unipolar rather than bipolar disorder.  These medications include 

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  • Selective serotonin reuptake inhibitors (SSRIs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Serotonin/norepinephrine reuptake inhibitors (SNRIs)
  • Bupropion
  • Mirtazapine
  • Tricyclic antidepressants (less commonly used)

Newer "atypical" antidepressants are also being tested for use in treating bipolar depression, and two (Seroquel and olanzapine-fluoxetine combination [Symbyax]) are FDA-approved as treatments for bipolar depression.

Note: In October 2004, the FDA determined that antidepressant medications can increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health care provider.

Treating a depressive episode in bipolar disorder is controversial and challenging. Using antidepressant medication alone is not recommended because the drugs may flip a person into a manic or hypomanic episode. Hypomania is a more subdued version of mania. Antidepressants alone also may lead to or worsen rapid cycling. In rapid cycling, a person may recover more quickly from depression -- but may experience mania followed by another episode of depression.

 

WebMD Medical Reference

Reviewed by Joseph Goldberg, MD on June 29, 2012

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