What are disadvantages of antidepressants for bipolar disorder treatment?

It cannot be stressed enough that the use of antidepressants in bipolar I can provoke manic episodes (in psychiatry this effect is known as switching) and can cause increased frequency of manic and depressive episodes (this effect is often referred to as cycle acceleration). In addition, antidepressants are generally ineffective in treating bipolar depression in people with bipolar I. They can be used in bipolar II, but with caution, and only if other treatments have been ineffective.

When used, they must be prescribed along with an anti-manic agent (e.g., lithium). Antidepressants can provoke hypomania, but of greater concern is the possibility that long-term antidepressant treatment may cause cycle acceleration in bipolar II patients. Antidepressants are a well-known cause of rapid cycling (e.g., experiencing four or more full-blown episodes a year).

Among antidepressants, the monoamine oxidase inhibitors (MAOIs) like Nardil and Parnate have the best track record in terms of effectiveness, although they are rarely used in the United States. Also effective are Wellbutrin and some other antidepressants such as Prozac and Zoloft. All carry some risks of switching, but this is much less likely if given alongside a mood stabilizer.

The antidepressant Effexor and older-generation antidepressants like Elavil are very prone to cause rapid cycling and cycle acceleration. Please note that not all health care professionals are aware of this information. It simply can't be stated often enough that antidepressants in bipolar disorder treatment must be handled by a skilled health care professional who understands these medications' direct effect on bipolar disorder mood swings.

It is never indicated for a person with bipolar disorder to be on an antidepressant without some form of anti-mania medication. There are no exceptions. If your loved one is on an antidepressant, it is essential that they discuss this issue with their prescriber.

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