Antidepressants No Help for Most People With Bipolar Disorder

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

Antidepressants No Help for Most People With Bipolar Disorder

“Because I’m not, in fact, depressed, Prozac makes me manic and numb,” writes Marya Hornbacher in her memoir, Madness: A Bipolar Life; “one of the reasons I slice my arm in the first place is because I’m … on something utterly wrong for what I have.”

Hornbacher’s referring to the period before her bipolar diagnosis, when her doctors incorrectly assumed that she was experiencing depression and gave her antidepressants to treat her symptoms. What they didn’t realize at the time was that the antidepressants were inducing dangerous bouts of mania that caused her to stay up for days at a time with no sleep, engaging in self-harming behavior while abusing drugs and alcohol.

Hornbacher’s not alone. According to statistics published in the journal Psychiatry in 2007, up to 80 percent of patients with bipolar disorder were prescribed antidepressants at some point in their treatment. In fact, until 2002, the drugs were considered a first line of defense against bipolar patients’ depressive episodes.

Prescribing patterns may have changed since then, but many people with bipolar disorder are still being prescribed these antidepressants to manage their symptoms. Only in recent years have experts come to understand the high risk that antidepressants can trigger a manic episode. And newer research is questioning whether the benefits of the drugs are worth the potential harm. 

In an analysis published in Neural Regeneration Research, doctors from the Mental Health Institute of Central South University in China reviewed all the previous studies of antidepressants for bipolar. They concluded that antidepressants simply aren’t effective in treating the disorder. The drugs also didn’t appear to relieve symptoms or promote remission of the illness any better than placebos or other medications.

When Patients Need Antidepressants
That doesn’t mean that there isn’t a place for antidepressants in bipolar disorder treatment, however. Some experts contend that antidepressants can be helpful for certain people—like those who have long periods of depression with few or no symptoms of mania, for example. The key thing, however, is that the drugs shouldn't be prescribed alone.

Instead, mental health professionals now insist that antidepressant drugs be used in conjuction with mood-stabilizing drugs like lithium. This combination helps to regulate mood swings and prevent “switching”—the drastic, sudden change from depression into mania, often caused by taking an antidepressant medication by itself.

Taking Antidepressants Safely
If you and your doctor do 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 doctor about all of your symptoms. Because mania can make people feel euphoric, happy and productive, many patients only seek help when they feel depressed. This can lead the doctor to treat only that problem. Be sure you also tell your doctor about any symptoms of mania, such as scattered, 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 suicidal, that’s something your health care provider needs to know immediately.
  • Take your medication as it’s prescribed to you. Always follow your doctor’s exact instructions when taking bipolar medication, and keep taking your medication even if you’re feeling better. Skipping or changing your doses increases your risk of rapid cycling and symptom relapse.

Antidepressants should usually only be taken for a short period of time and always with caution. It’s critical that you stay in close contact with your doctor 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. And regardless of your treatment program, make sure your doctor is a skilled expert that specializes in diagnosing and treating bipolar disorder. 

Medically reviewed in February 2021.

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