Traditional antidepressants are considered "experimental" for treating bipolar depression in that none has been proven to be more effective than a placebo (sugar pill) in bipolar I disorder. If taken alone, some may actually worsen symptoms of bipolar or flip a person 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 four or more distinct episodes of mania/hypomania or depression over a 1-year period. This person may be more prone to have a relapse or go into the next phase of illness sooner and more often than people without rapid cycling.
Studies also have shown that antidepressant medications may not provide additional benefit for bipolar depression if they're taken along with a mood stabilizer such as lithium or Depakote. But your doctor may prescribe newer antidepressants known as SSRIs (selective serotonin reuptake inhibitors) for treating depression in bipolar disorder – along with lithium or other mood-stabilizing drugs such as valproate, carbamazepine, or an atypical antipsychotic. People with bipolar II depression may be treated safely (at least in the short term) with antidepressants.
If and when an antidepressant is effective for someone with bipolar depression, it is believed that the medicine works by boosting the functioning of nerve cells in the brain that communicate through the chemical (neurotransmitter) serotonin.
This class of antidepressants includes:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
Vilazodone (Viibryd) and vortioxetine (Trintellix, formerly called Brintellix) 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 most 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 ways 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:
- Erectile dysfunction
- Loss of libido
- Weight gain or loss
What Are the Risks?
In people with bipolar disorder, SSRIs and other antidepressants carry a risk of bringing about mania. So it's important to monitor for signs of excess energy, decreased need for sleep, or abnormal and excessive mood elevation. The FDA also recommends closely watching young people (children and adolescents) treated with SSRIs or other antidepressants for worsening depression or the beginning of suicidal tendencies. It is sometimes hard to tell whether suicidal thoughts or behaviors that happen or get worse during antidepressant treatment are the result of the antidepressant itself or of the ongoing depression that the antidepressant may not be effectively treating. For this reason, the FDA recommends careful monitoring of patients being treated with these drugs – especially at the beginning of therapy and when doses change.
If you have questions or concerns, discuss them with your health care provider.