The use of traditional antidepressants to treat bipolar depression is considered experimental. This is because these medicines have not been proven effective for treating bipolar depression and, therefore, none are FDA-approved for that indication. There is no research to show that they have any greater benefit than taking a mood stabilizer (such as lithium or Depakote) alone. Many of the existing studies of their efficacy have focused mainly on people with unipolar rather than bipolar disorder.
Using antidepressant medication alone to treat a depressive episode is not recommended in people with bipolar I disorder. The drugs may flip a person, particularly a person with bipolar I disorder, into a manic or hypomanic episode. Hypomania is a more subdued version of mania. Using antidepressants alone also may lead to or worsen rapid cycling in some bipolar patients. In rapid cycling, a person has 4 or more distinct episodes of mania/hypomania or depression over a 1-year period. This person may be more prone to experience a relapse or the next phase of illness sooner and more often than people without rapid cycling.
Under close supervision, antidepressants are sometimes used to treat the depressive symptoms of bipolar disorder. If an antidepressant is effective, it usually takes at least 4-6 weeks for people to respond to treatment. Sometimes a doctor will try several different medicines before finding one that might work for a patient. These medications include SSRIs such as Prozac or Zoloft, SNRIs such as Effexor, and novel antidepressants such as Wellbutrin.
Note: The FDA has 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.