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Antidepressants and Bipolar Disorder

Written by Rachel Nall, RN, BSN | Published on August 10, 2015
Medically Reviewed by The Healthline Medical Review Team on August 10, 2015

What Is Bipolar Disorder?

Bipolar disorder is a condition that causes sudden shifts in mood, from depression to mania. During mania (a manic episode), a person with bipolar disorder may experience an extremely elevated mood and racing thoughts. They may be easily irritated and talk very quickly and for long periods. During a manic episode, a person with bipolar disorder may practice risky behaviors, such as spending excessive amounts of money or engaging in unsafe sex.

Six types of bipolar disorder are listed in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), published by the American Psychiatric Association:

  • bipolar I disorder
  • bipolar II disorder
  • cyclothymic disorder
  • substance/medication-induced bipolar and related disorders
  • bipolar and related disorders due to another medical condition
  • unspecified bipolar and related disorders

A person with bipolar I disorder has manic episodes that last at least seven days or require a hospital stay. These may be followed by depressive episodes that last two weeks or more. Bipolar II disorder is when a person has a mix of depressive and manic episodes, with manic episodes that are not as severe (hypomania) as in bipolar I disorder. Cyclothymic disorder is when a person has numerous periods with symptoms of mania or depression, without the intensity of mania or depression seen in bipolar disorder. Substance/medication-induced bipolar disorder is caused by prescription or abused drugs. Some drugs can trigger mania, including steroids (like dexamethasone) or cocaine. Bipolar disorder due to another medical condition occurs when someone becomes manic due to another illness. It can happen weeks before the other illness is diagnosed. Illnesses that can cause this include Cushing’s disease, multiple sclerosis, stroke, or traumatic brain injuries. Unspecified bipolar and related disorders may be the diagnosis when the picture of someone’s mood changes is not complete or the doctor does not have enough facts to make a more specific diagnosis.

Bipolar disorder type I, bipolar disorder type II, and cyclothymia can’t be cured, but doctors can treat them. Bipolar disorder due to substances or drugs may improve or disappear when the drug or substance causing them is stopped. Bipolar disorder due to another medical condition may improve or stabilize when the underlying condition is treated.

Treating bipolar illness can be complex, and doctors may prescribe several different types of medication before patients experience better mood control.

What Are Antidepressants?

Depression in bipolar disorder can be severe and may even cause suicidal thoughts. While antidepressants treat depression, a person with bipolar disorder also experiences bouts of mania. For this reason, antidepressants aren’t always the most effective treatment.

Antidepressants increase the amount of neurotransmitters in the brain. Examples include serotonin, norepinephrine, and dopamine. These are feel-good chemicals that can lift a person’s mood, reducing depressed feelings. The use of antidepressants for bipolar disorder has been controversial because antidepressants have triggered manic episodes in a small percentage of people with bipolar disorder.

What Have Studies Shown Related to Antidepressants and Bipolar Disorder?

The International Society for Bipolar Disorders (ISBD) formed a task force to study antidepressant use in people with bipolar disorder. Members reviewed more than 173 studies on bipolar disorder and antidepressants and found that they couldn’t conclusively recommend antidepressants to treat bipolar disorder.

Other important findings include that selective serotonin reuptake inhibitors (SSRIs) and bupropion were less likely to cause manic episodes than other drugs, such as tricyclic antidepressants. The task force published their findings in the American Journal of Psychiatry.

Researchers at Brown University presented a study on bipolar disorder and antidepressants at the 2013 American Psychiatric Association meeting. The researchers didn’t find a higher rate of hospital readmission rates in patients who took antidepressants, compared to those who did not. Researchers studied 377 patients and found that 211 of the patients came back to the hospital within a year after discharge.

Are Antidepressants Used to Treat Bipolar Disorder?

Antidepressants aren’t usually the first drugs a doctor would prescribe to treat bipolar disorder. The first group of drugs to treat bipolar disorder is typically mood stabilizers, such as lithium. Sometimes a doctor will prescribe a mood stabilizer and antidepressant together. This reduces the risk of manic episodes. Mood stabilizers aren’t the only medications used to treat bipolar disorder.

Anti-seizure medication is also used to treat bipolar disorder. Although developed to treat seizures, these drugs stabilize nerve membranes and prevent the release of some neurotransmitters, which helps patients with bipolar disorder. These drugs include divalproex (Depakote), carbamazepine (Tegretol), lamotrigine (Lamictal), and oxcarbazepine (Trileptal).

Another group of drugs used to treat bipolar disorder are atypical anti-psychotic drugs, like olanzapine (Zyprexa) and risperidone (Risperdal). These drugs affect several neurotransmitters in the brain, including dopamine, and often make people drowsy.

Many doctors do combine small doses of antidepressants with mood stabilizers to treat bipolar disorder. Some antidepressants are used more often than others.

Antidepressants Used for Bipolar Disorder

Antidepressants have not been well-studied in the treatment of bipolar disorder, but psychiatrists and other mental health providers do sometimes prescribe them in combination with other drugs, to treat bipolar disorder. The ISBD Task Force recommends that doctors prescribe these antidepressant types first to treat bipolar disorder:

  • selective serotonin reuptake inhibitors (SSRIs), such as Celexa, Lexapro, Paxil, Prozac, and Zoloft
  • Bupropion, such as Wellbutrin

These antidepressants have a higher risk of triggering mania, so they are used only if other antidepressants didn’t work for a patient:

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

What Side Effects Can Antidepressants Cause?

Antidepressants can cause several different side effects. These include:

  • agitation
  • headaches
  • nausea
  • sleepiness
  • reduced sex drive

Taking medications regularly is often a challenge for those struggling with bipolar disorder. One day they may feel “normal” or fine and feel like they don’t need their medicine anymore. Or they could feel so sad or hyper that they are not able to take their medicine. Suddenly stopping antidepressants can make bipolar symptoms worse. Those with bipolar disorder shouldn’t stop taking their antidepressants unless a doctor tells them to.

Conclusions on Antidepressants and Bipolar Disorder

Antidepressants are an option to treat bipolar disorder, but they aren’t usually the only medicine used. They’re mostly prescribed with other medications, such as a mood stabilizer or antipsychotic. This can prevent manic episodes and help people better control their moods.

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