Older tricyclic antidepressants used for treating bipolar disorder may be more likely to trigger a manic episode or rapid cycling than other depression drugs. They also tend to have more side effects than newer generation antidepressants, and can be especially dangerous in overdose. However, they are occasionally still used when other antidepressants are not effective, or when certain other conditions (such as migraine or neuropathic pain disorders) are also present. Like all antidepressants, experts recommend against taking a tricyclic medication without a mood stabilizer (such as lithium or divalproex) to minimize the chance of inducing mania symptoms.
People with bipolar disorder often have cycles of elevated and depressed mood that fit the description of "manic depression." When a person's illness follows this classic pattern, diagnosing bipolar disorder is relatively easy.
But bipolar disorder can be sneaky. Symptoms can defy the expected manic-depressive sequence. Infrequent episodes of mild mania or hypomania can go undetected. Depression can overshadow other aspects of the illness. And substance abuse can cloud the picture.
Tricyclic antidepressants work by increasing levels of the mood chemicals serotonin and norepinephrine in the brain. However, because they may sometimes increase the risk of mania or rapid cycling -- as well as heart problems if you take heart medication -- these drugs are less often recommended for bipolar disorder.
WebMD Medical Reference with The Cleveland Clinic: "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 with The Cleveland Clinic: "Effects of Untreated Depression." American Psychiatric Association: "Practice Guideline for the Treatment of Patients With Bipolar Disorder."
Joseph Goldberg, MD on October 18, 2014