Traditional antidepressants are considered experimental in treating bipolar depression, because none are FDA-approved for that purpose, and there is no research to show that they have any greater benefit than taking a mood stabilizer (such as lithium or Depakote) alone. Nevertheless, your doctor may prescribe newer antidepressants known as SSRIs (selective serotonin reuptake inhibitors) for treating depression in bipolar disorder. They are usually prescribed along with lithium or other antimanic drugs such as valproate, carbamazepine or an atypical antipsychotic.
SSRIs are believed to work by boosting the functioning of nerve cells in the brain that communicate through the chemical (neurotransmitter) serotonin.
Rapid cycling is a pattern of frequent, distinct episodes in bipolar disorder. In rapid cycling, a person with the disorder experiences four or more episodes of mania or depression in one year. It can occur at any point in the course of bipolar disorder, and can come and go over many years depending on how well the illness is treated; it is not necessarily a "permanent" or indefinite pattern of episodes.
Viibryd (vilazodone) and Brintellix (vortioxetine) are two newer antidepressants that affect the serotonin transporter as well as other serotonin receptors in the brain.
Most antidepressants take several weeks to start working. Though the first one that is prescribed works in the majority of people, others may need to try two or three to find the right one. Your doctor may also prescribe a sedative to help relieve anxiety, agitation, or sleep problems while the antidepressant begins to work.
SSRI Side Effects
SSRI side effects are generally milder than those of the older classes of antidepressants. There are many strategies to counteract the common side effects of SSRIs if they develop, and some side effects may occur only briefly at the beginning of treatment.
Common SSRI side effects may include:
Loss of libido
Weight gain or loss
In people with bipolar disorder, SSRIs and other antidepressants carry a risk of inducing mania, making it essential to monitor for signs of excess energy, decreased need for sleep, or abnormal and excessive mood elevation. The FDA also recommends closely observing young people treated with SSRIs or other antidepressants for worsening depression or the emergence of suicidal tendencies. It is unclear whether antidepressants contribute to the emergence of suicidal thinking and behavior. However, the FDA indicates a need for careful monitoring of patients being treated with these drugs -- especially at the beginning of therapy and during dose changes.
WebMD Medical Reference: "Bipolar Disorder (Manic Depressive Disorder)."
WebMD Assess Plus: Bipolar Disorder Assessment.
National Institute for Mental Health: "Step-BD Womens Studies."
Massachusetts General Hospital Bipolar Clinic & Research Program.
MedicineNet.com: "Bipolar Disorder (Mania)."
WebMD Medical Reference: "Effects of Untreated Depression."
American Psychiatric Association: "Practice Guideline for the Treatment of Patients With Bipolar Disorder."