Are Antidepressants Safe and Effective in Bipolar Depression Treatment?

The effectiveness and safety of antidepressants for bipolar depression treatment has been called into question by psychiatrists, researchers, and people living with bipolar depression. In fact, according to Dr. Nassir Ghaemi, director of the Bipolar Disorders Program at Emory University School of Medicine, “The use of antidepressants in bipolar disorder is perhaps the most controversial topic in the treatment of bipolar disorder” (Cascade, et al., 2007). Here’s a peek into the controversy to arm you with information about the safety and effectiveness of antidepressants for bipolar depression treatment.

Antidepressants in Bipolar Depression: What Changed?

Antidepressants used to be the go-to treatment for bipolar depression. They were typically the first medication prescribed, and often they were the only medication used. Then, in 2002, considering emerging studies and negative patient experiences, the American Psychiatric Association (APA) changed its recommendation: antidepressants should not be the first line of treatment; lithium or Lamictal should be used first.

Professional opinion differs regarding whether to follow the APA’s recommendation. It’s not for lack of research; the problem is that different studies yield conflicting information. One study will find, for example, that antidepressants destabilize someone’s mood and lead to rapid cycling of depression and mania or hypomania. However, another study will show that the use of antidepressants alone (called antidepressant monotherapy) helps depression with little risk of inducing mania.

This ambiguity can be frustrating for people living with bipolar depression who just want to feel better, return to normal functioning, and avoid swinging into a manic episode. A consultation with one psychiatrist might lead to a recommendation of antidepressants, but a psychiatrist giving a second opinion might advise that antidepressants be strictly avoided. By informing yourself of the pros and cons, you can avoid feeling caught in the middle between the two sides of the bipolar depression antidepressant debate.

Do Antidepressants Help or Harm? The Advantages and Disadvantages of Antidepressant Treatment in Bipolar Disorder

Using antidepressants for bipolar depression treatment could produce a few different results:

• Your depression might improve, but the medication might work too well, leading to a manic or hypomanic episode, or a mixed episode which means the return of depression symptoms
• Your depression might stay the same, unaffected by the medication
• Your depression might be unaffected and your mood might destabilize, causing mania, mixed episodes, and rapid cycling

Mental health professionals in favor of using antidepressants in helping people with bipolar depression believe that with continued use, antidepressants lower the risk of relapse. Symptoms will go away and stay away because of the way antidepressants work in the brain.

Those that oppose prescribing antidepressants to people fighting bipolar depression believe that antidepressants:

• Destabilize mood, inducing manic or mixed episodes
• When paired with a mood stabilizer as often done, are rendered ineffective because the combination of medications cancels each other out
• Don’t work well on their own or with mood stabilizers

Who Should (and Shouldn’t) Use Antidepressants to Treat Bipolar Depression?

Sometimes people wonder if there are certain groups who should (or shouldn’t) take antidepressants when they have bipolar depression. Because there are so many individual differences and a variety of variables that apply, there isn’t a straightforward answer to this question. This checklist can help you and your doctor decide if antidepressants are a good idea:

• Have you successfully used antidepressants for bipolar depression in the past?
• Have you stopped taking antidepressants only to have your symptoms worsen?
• Are your mood episodes confined to depression and mania/hypomania without mixed episodes and no instances of rapid cycling between mood episodes?

Generally, “yes” answers can indicate that antidepressants might be safe and effective in your bipolar depression treatment. “No” answers could caution against taking antidepressant medications.

If after careful consideration of your personal history and experience with bipolar disorder and treatment, you and your psychiatrist decide that antidepressants will be safe and effective in your treatment, consider these guidelines recommended by a variety of researchers and mental health professionals:

• Avoid using antidepressants as your sole form of medication
• Antidepressants should be paired with mood stabilizers or perhaps other medications such as antipsychotics or anticonvulsants

While it appears that there is more evidence against antidepressant use in bipolar depression than in favor of it, the jury is still out regarding the safety and effectiveness of antidepressants for bipolar depression treatment. Studies have been done, but more are needed. Currently, too little evidence is available to declare with certainty that antidepressants are safe or dangerous, effective or ineffective in treating the depression side of bipolar disorder.
 
Perhaps the best thing to do is to be informed and have open conversations with your doctor. Regardless of what prescription medication you take, know yourself and your symptoms, and alert your doctor when something isn’t right. This is a great way to be active in your treatment so you can manage bipolar depression, with or without antidepressants.

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