Role of Antidepressants in Bipolar Disorder & Which Antidepressants are Recommended for Treatment of Bipolar Disorder?

Bipolar disorder is a chronic mood disorder that affects millions of people worldwide (1). There is no cure for bipolar disorder; and treatment revolves around managing the symptoms (2). Antidepressants have been used by many doctors to treat bipolar disorder, along with therapy. A combination of medication and talk therapy are the typical modes of treatment for bipolar disorder (1, 2). In the initial stages of bipolar disorder, psychiatrists will recommend that you begin with traditional medications so as to get your symptoms under control as soon as possible. With the symptoms of bipolar disorder under control, you can then begin some form of maintenance treatment to lower your risk of a relapse. As the depressive episodes of bipolar disorder can be quite severe and even lead to suicidal thoughts, antidepressants are usually considered to treat these symptoms and get results at the earliest (1, 2). However, are antidepressants the most effective treatment for bipolar disorder? Let us take a look at the exact role of antidepressants in bipolar disorder.

Antidepressants and Bipolar Disorder

A bipolar disorder patient has rapidly changing mood swings, which range from euphoria to depression (3). The depressive episodes in bipolar disorder can range from moderate to severe and can also lead to suicidal thoughts (2). Antidepressants are typically used for treating depression, but the fact is that a patient of bipolar depression also suffers from experiencing bouts of mania. Due to this reason, many medical experts are of the opinion that antidepressants are not necessarily the most effective treatment for bipolar disorder.

Antidepressants are known to boost the level of neurotransmitters in the brain, such as norepinephrine, dopamine and serotonin. These are all the ‘feel-good’ chemicals of our body, which boosts a person’s mood and also lowers feelings of depression. When antidepressants are used for treating bipolar disorder, they have been observed to trigger manic episodes in a certain percentage of bipolar patients.

In fact, to validate this observation, the International Society for Bipolar Disorders (ISBD) put together a task force that would look at the use of antidepressants in people suffering from bipolar disorder. The members of this task force researched nearly 175 studies and clinical trials that have been done on bipolar disorder and antidepressants. They found that it was not possible to conclusively prescribe antidepressants for treating bipolar disorder.

Some of the other findings of this task force also included the fact that bupropion and SSRIs (selective serotonin reuptake inhibitors) were a lot less likely to cause manic episodes when compared to other drugs. The complete findings of the USBD task force have since been published in the American Journal of Psychiatry.

Furthermore, a research team at Brown University conducted a study on antidepressants and bipolar disorder and presented their findings in 2013 at the meeting of the American Psychiatric Association. The research team did not find an increase in hospitalization re-admission rates in bipolar patients who were taking antidepressants as compared to those who were not taking antidepressants. Of the 377 patients that were in the study, 211 of them came back for hospitalization just within a year of getting discharged after being treated for bipolar disorder.

Other Than Antidepressants, What Other Medications Are Used To Treat Bipolar Disorder?

Technically, antidepressants are not the first drugs that a doctor prescribes for treating bipolar disorder. In fact, the first class of drugs for treating bipolar disorder is generally mood stabilizers, such as lithium (4). At times a doctor may prescribe an antidepressant together with a mood stabilizer, but very rarely will a doctor prescribe an antidepressant alone. This combination of medications is known to lower the risk of manic episodes. Nevertheless, mood stabilizers are not the only medications that are used for treating bipolar disorder.

Many doctors also prefer to use anti-seizure medications for treating bipolar disorder and though these medications have originally been designed to treat seizures, these drugs have shown immense promise in treating bipolar disorder (5). This is because anti-seizure medications stabilize the nerve membranes and are able to inhibit the release of certain transmitters, the prevention of which helps provide relief to patients of bipolar disorder. Some of these drugs include:

  • Lamictal (lamotrigine)
  • Trileptal (oxcarbazepine)
  • Depakote (divalproex)
  • Tegretol (carbamazepine)

Atypical antipsychotic drugs are also used for treating bipolar disorder (6). This class of drugs is known to have an impact on many neurotransmitters in the brain including dopamine. These effects make people drowsy and let them have a good night’s sleep. These drugs include:

  • Risperdal (risperidone)
  • Zyprexa (olanzapine)

Many doctors prefer combining mood stabilizers with smaller doses of antidepressants to treat bipolar disorder and certain antidepressants are preferred for this over others.

Which Antidepressants are Recommended for Treatment of Bipolar Disorder?

Antidepressants have not really been studied thoroughly for use in treating bipolar disorder. However, there are many times when mental health providers and psychiatrists prescribe antidepressants to patients of bipolar disorder, but usually in combination with other medications or other classes of drugs. According to guidelines of the ISBD Task Force, doctors should be prescribing the following antidepressants first for treating bipolar disorder.

  • Bupropion (brand name Wellbutrin)
  • SSRIs such as Lexapro, Paxil, Celexa, Zoloft and Prozac

There are certain identified antidepressants that are known to increase the risk of manic episodes and are only used if the other antidepressants do not work for a patient. These include:

  • Tricyclic antidepressants (TCAs) such as Elavil, Tofranil, and Pamelor
  • SNRIs (serotonin-norepinephrine reuptake inhibitors) such as Effexor, Pristiq, and Cymbalta

Side Effects of Antidepressants

There are many known side effects of antidepressants, but they also tend to affect different people in different ways. Nevertheless, some of the general side effects of consuming antidepressants include: Reduced sex drive, nausea, agitation, irritability, headaches and inability to sleep (7).

When you are struggling with bipolar disorder, one of the biggest challenges becomes taking regular medications. You wake up one day feeling ‘normal’ and perfectly fine and you may feel like you don’t need these medications anymore. On other days, you may feel so depressed or hyper that you are unable to take your medication.

If you stop taking your antidepressants suddenly, then you will experience a sharp worsening of your bipolar symptoms. Until unless your doctor advises you to stop taking the antidepressants, you should keep on taking the medications regularly for your bipolar disorder.

Conclusion

Antidepressants are one option of treating bipolar disorder, but they are not the only option and neither are they the primary option considered for treating bipolar disorder. Antidepressants are typically prescribed with other medications, such as antipsychotics and mood stabilizers for treating bipolar disorder. Combination therapy works best for controlling the symptoms of bipolar disorder and also prevents the occurrence of manic episodes (8).

Reference Links

  1. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
  2. https://www.medicalnewstoday.com/articles/324349.php
  3. https://www.mentalhealthamerica.net/conditions/mood-disorders
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310104/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181564/
  6. https://www.ncbi.nlm.nih.gov/pubmed/15826735
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696739/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310104/

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