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Bipolar Disorder Health Center

SSRI Antidepressants for Bipolar Disorder

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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.

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This class of antidepressants includes:

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:

  • Nausea
  • Nervousness
  • Insomnia
  • Diarrhea
  • Rash
  • Agitation
  • Erectile dysfunction
  • 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

Reviewed by Joseph Goldberg, MD on July 31, 2014

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