Antidepressants for Bipolar Disorder: Are They Helpful?

Prescribing antidepressants alone for bipolar disorder could actually increase manic episodes in patients.

Woman holds her bottle of antidepressants for bipolar disorder

Updated on January 18, 2024.

Antidepressants are often prescribed for bipolar disorder, partly because some people aren’t able to tolerate other treatments or don’t find them effective. In fact, until 2002, antidepressants were considered a first line of defense against bipolar depressive episodes.

In the years since, mood stabilizers like lithium and valproate have become the gold standard of treatment. That’s because experts have come to understand the high risk that antidepressants, when taken alone, can trigger a manic episode in a person with bipolar disorder. Newer research is questioning whether the benefits of the drugs are worth the potential harm. 

A 2018 meta-analysis published in the International Journal of Bipolar Disorders found that there was a serious lack of useful data about the effectiveness of antidepressants as a treatment for bipolar disorder. The researchers concluded that their use as a frontline treatment isn’t well supported and they should be taken very cautiously, only as part of a carefully monitored plan.

When people with bipolar disorder need antidepressants

That doesn’t mean that there isn’t a place for antidepressants in bipolar disorder treatment, however. The 2018 study also found that modern antidepressants are useful in short-term treatment of bipolar 2 and that the risk of triggering a manic episode can be offset by combining them with mood stabilizers. This suggests that antidepressants can be helpful for certain people—like those who have long periods of depression with few symptoms of mania. The key point, however, is that these drugs shouldn't be prescribed alone.

Mental healthcare providers (HCPs) now recommend that antidepressant drugs be used only in conjunction with mood-stabilizing drugs like lithium. This combination helps to regulate mood swings and prevent switching—the drastic, sudden change from depression into mania, sometimes caused by taking an antidepressant medication by itself.

Taking antidepressants safely

If you and your HCP decide that antidepressants are right for you, it’s critical to make sure you’re taking them safely. Follow these guidelines to ensure that your treatment is effective and correct for the type of bipolar disorder that you have.

Talk to your HCP about all of your symptoms. Because mania can make people feel euphoric, happy, and productive, many only seek help when they feel depressed. This can lead the HCP to treat only that problem. Be sure you also tell your HCP about any symptoms of mania, such as scattered or racing thoughts, agitation, excess energy, or inability to sleep. Engaging in dangerous thrill-seeking behavior like shoplifting is also considered a symptom of mania.

Always report side effects. If the medication you’re taking is making you feel agitated, overly depressed, or given to self-harm, that’s something your HCP needs to know immediately.

Take your medication as it’s prescribed to you. Always follow your HCP’s exact instructions when taking bipolar medication. Keep taking it even if you’re feeling better. Skipping or changing your doses increases your risk of rapid cycling and symptom relapse.

Antidepressants are usually taken for a short period of time and always with caution. It’s critical that you stay in close contact with your HCP throughout your treatment and keep the dialogue open. Learn about all medications you’re taking and be honest about any questions or concerns you have. It’s a wise idea to avoid alcohol and illicit drugs, as well.

During this time, your treatment may also involve therapy, which can help you talk about your disorder, recognize certain thoughts and behaviors, and move to address them. Receiving support from family, caregivers, close friends, and other loved ones can be a vital part of your care, too. 

Regardless of your treatment program, make sure your HCP is a skilled expert that specializes in diagnosing and treating bipolar disorder.

Article sources open article sources

American Psychological Association. Diagnosing and treating bipolar spectrum disorders. January 1, 2022.
Gitlin MJ. Antidepressants in bipolar depression: an enduring controversy. Int J Bipolar Disord. 2018 Dec 1;6(1):25. 
National Institute of Mental Health. Bipolar Disorder. Revised 2022.
American Psychiatric Association. What Are Bipolar Disorders? January 2021.
American Psychiatric Association. Treating Bipolar Disorder: A Quick Reference Guide. Accessed January 2024.
Harvard Health Publishing. Going off antidepressants. May 15, 2022.
Jain A, Mitra P. Bipolar Disorder. StatPearls Publishing. Last updated February 20, 2023.

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