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 uncover a manic episode. Studies also have shown that they may not provide additional benefit for bipolar depression if they're are taken along with a mood stabilizer such as lithium or Depakote. Nevertheless, 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.
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)
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:
- 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 sometimes difficult to know whether suicidal thoughts or behaviors that occur or worsen 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 during dose changes.