Antidepressants

"Antidepressant" is a general description of several classes of drugs, which, as the name implies, are designed to combat depression.

These drugs have also been found to be useful in dealing with the depressive phase of bipolar disorder, however antidepressants are NOT commonly prescribed to people with documented bipolar disease.  They are typically prescribed to people when their bipolar disorder is not known and they are experiencing a depressive phase.

There can be complications with antidepressants with bipolar patients because the antidepressants change the brain chemistry and can shoot a person into the mania stage.

Where Antidepressants Fit In

Antidepressants are usually coupled with mood stabilizing drugs that are more useful against mania. When used this way, both the highs and lows of bipolar disorder can be more easily managed. On the whole, drugs are considered an essential part of the management of bipolar disorder.

How Do Antidepressants Work

Antidepressants are occasionally prescribed in conjunction with mood stabilizers when used to treat bipolar disorder. The mood stabilizers tend to be more effective in handling the manic phase of the disorder, and can also help minimize the possibility of certain side effects.

Learn how antidepressants and other medications work inside the brain using Healthline's Bodies in Motion.

The different classes of antidepressants work in distinct ways. These are some of the main types:

SSRIs

Selective serotonin reuptake inhibitors, also known as SSRIs, are a class of antidepressants and are considered a first choice for treating bipolar disorder because they tend to have less troublesome side effects.

They work by preventing serotonin from being reabsorbed by the brain. Serotonin is a neurotransmitter that helps convey information through the nervous system. It is associated with emotion.

There are two other groups of antidepressants that work similarly to SSRIs, but work on other neurotransmitters. These are norepinephrine and dopamine reuptake inhibitors, also known as NDRIs; and serotonin and norepinephrine reuptake inhibitors, or SNRIs.

Tricyclic antidepressants

The name comes from the drugs' three-ring chemical structure. They work similarly to the uptake inhibitors, but tend to have more side effects. These drugs have been around since the 1950s.

Monoamine oxidase inhibitors (MAOIs)

These drugs prevent an enzyme that scrubs serotonin and dopamine out of the nervous system from doing its job.

There are also "atypical antidepressants" which do not neatly fit into one of the other categories.

Who Can Take Antidepressants

Antidepressants are widely prescribed drugs, but there have been warnings attached to them in recent years concerning a link to increased risk of suicide among young adults (late teens and early 20s.)

Side Effects

Antidepressants have been linked to an increased risk of suicidal behavior and thoughts in young people, according to the U.S. Food and Drug Administration. The risk is for people between 18 and 24.

Antidepressants can also cause a condition called serotonin syndrome. People with this syndrome have a glut of serotonin in their system. Symptoms include chills, pronounced sweating, restlessness, diarrhea, headache and confusion.

One of the concerns behind antidepressants being prescribed along with a mood stabilizer is the possibility of the antidepressants kick-starting a manic or rapid-cycling phase in the patient.

A bipolar person cycles between manic and depressive phases. If a person has four or more of these cycles in a year, it is known as rapid-cycling. In some cases, cycling can happen in a matter of hours.

MAOIs can cause potentially life-threatening conditions like hypertensive crisis—an increase in blood pressure that can lead to a stroke—if certain foods are ingested. People taking MAOIs must adhere to a strict diet that avoids foods like cheese, aged meat, and red wine. These medications can have similar effects if combined with some other drugs, particularly decongestants.

There are other side effects associated with antidepressants. The side effects vary with each. They can include:

  • loss of sex drive or function.
  • nausea.
  • nervousness tremors.
  • sweating
  • changes in blood pressure.
  • dry mouth.
  • insomnia
  • dry mouth.

Availability

Available SSRIs include Celexa (citalopram), Luvox/Solvay (fluvoxamine),Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine) and Zoloft (sertraline) .

The SNRIs include Cymbalta (duloxetine) and Effexor (venlafaxine).

NDRIs include  Wellbutrin (buproprion hydrochloride).

Tricyclic antidepressants include Elavil (amitriptyline) and Tofranil (imipramine).

MAOIs include Nardil (phenelzine) and Parnate (tranylcypromine).

Highlights

There are a number of classes of antidepressants, each working in a different way to counter depression.

Antidepressants are occasionally paired with a mood-stabilizing drug but risk inducing a manic or rapid-cycling phase in a bipolar person.

A heightened risk of suicide in young adults has been linked to antidepressants.

What The Experts Say

Dr. Soroya Bacchus, a psychiatrist based in Los Angeles, said antidepressants are useful when there is a depressed mood phase in bipolar disorder, though lithium (a mood stabilizer) can elevate a depressed mood by itself.

"The better antidepressants are the SSRI's—Prozac, Zoloft—and Wellbutrin. Paxil is often problematic and known to (precipitate) mania," Dr. Bacchus said.

"Most SNRI's like the old tricyclic antidepressants, Effexor, Cymbalta and all stimulants can (precipitate) mania. Often when the depressed or manic states of bipolar stabilize, a mood stabilizer can be the only necessary daily drug where the others can be stopped."