Bipolar disorder is a condition that causes sudden shifts in mood, from depression to mania. Treating it can be complex, and doctors may prescribe several medications. One common way to treat bipolar disorder is with antidepressants, which increase neurotransmitters in the brain.
During mania, 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. They may also practice harmful behaviors such as spending excessive amounts of money.
Types of bipolar disorder listed in the “Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)”
- bipolar I disorder, which causes long or intense manic episodes
- bipolar II disorder, which causes less severe mania than bipolar I disorder
- cyclothymia, or cyclothymic disorder, which causes less severe symptoms overall
- bipolar disorder unspecified
These types of bipolar disorder cannot be cured, but doctors can treat them.
Antidepressants increase the number of neurotransmitters in the brain. These feel-good chemicals can lift a person’s mood, reducing depressed feelings.
Examples of neurotransmitters include:
Depression in bipolar disorder can be severe and may even cause suicidal thoughts. While antidepressants can help relieve symptoms of depression, they do not help with bouts of mania. For this reason, antidepressants are not always the most effective treatment for people with bipolar disorder.
The use of antidepressants for bipolar disorder has also been controversial because antidepressants have triggered manic episodes in a small percentage of people with the condition, according to a 2018 literature review.
General practice guidelines for clinicians
Antidepressants have not been well-studied in treating bipolar disorder, but psychiatrists and other mental health professionals sometimes prescribe them in combination with other medications.
- Generally, there’s insufficient proof that antidepressants are an effective treatment for bipolar disorder.
- They may cause a treatment-emergent affective switch (TEAS), which is when a person enters into a mania or depression episode within 8 weeks of beginning treatment.
- However, mood stabilizers are not associated with TEAS when added to mood stabilizers. Certain people will require combined treatment with these medications.
- It appears to be safe for short-term treatment of Bipolar II.
These conclusions support the findings of the International Society for Bipolar Disorders (ISBD) in 2012.
Members reviewed multiple studies on antidepressants and bipolar disorder and found that they could not conclusively recommend antidepressants to treat bipolar disorder. However, they acknowledged that some individuals might find antidepressants helpful.
The ISBD Task Force recommends that doctors prescribe these antidepressant types first to treat bipolar disorder:
- SSRIs, such as:
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- paroxetine (Paxil, Paxil CR)
- sertraline (Zoloft)
- bupropion (Forfivo, Wellbutrin SR, Wellbutrin XL)
These antidepressants have a higher risk of triggering mania, so they are used only if other antidepressants did not work for a person:
- serotonin-norepinephrine reuptake inhibitors (SNRIs), such as:
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta)
- venlafaxine (Effexor XR)
- TCAs, such as:
- amitriptyline (Elavil)
- imipramine (Tofranil)
- nortriptyline (Pamelor)
Antidepressants are not 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 are not the only medications used to treat bipolar disorder.
Antiseizure 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 people with bipolar disorder. These drugs
- carbamazepine (Tegretol)
- divalproex (Depakote)
- lamotrigine (Lamictal)
- oxcarbazepine (Trileptal), which may be prescribed off-label
Another group of drugs used to treat bipolar disorder is atypical antipsychotic 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 can cause several different side effects. These include:
Taking medications regularly is often a challenge for those living with bipolar disorder. One day they may feel “normal” or fine and feel like they do not need their medication anymore. They could also feel so sad or hyper that they are not able to take their medication.
Suddenly stopping antidepressants can make bipolar symptoms worse. Those with bipolar disorder should not stop taking their antidepressants unless a doctor tells them to.
Antidepressants are an option to treat bipolar disorder, but they’re not usually the only medication used.
There may be some risks to taking antidepressants for bipolar disorder unless combined with other types of medications, such as a mood stabilizer or antipsychotic. This can prevent manic episodes and help people better control their moods.
However, they may be a good treatment for some people. Your doctor can tell you if these medications are the right fit for you.