Antidepressants for bipolar disorder: are they helpful?

Bipolar disorder is a mental illness that causes severe mood swings. A person can have manic episodes, during which they feel happy and energized, or depressive episodes, during which they feel sad and hopeless. Sometimes, during a mixed episode, a person can experience both manic and depressive symptoms.

Antidepressants are drugs that are prescribed to treat depression. They’re also often used for bipolar disorder, partly because some people aren’t able to tolerate other treatments or don’t find them effective.

But experts have come to understand that, when taken alone, antidepressants may pose a risk for people with bipolar disorder. They can trigger a manic episode or lead to rapid cycling, during which a person shifts mood episodes at least four times in 12 months. Some research questions whether the benefits of the drugs are worth the potential harm.

Mental healthcare providers (HCPs) recommend that antidepressants be used only in combination with mood-stabilizing drugs, which are considered to be the gold standard of treatment. These include medications like lithium, valproate, quetiapine, and lamotrigine. Combining the drugs helps to regulate mood swings and prevent switching—the drastic, sudden change from depression into mania, possibly 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.

Report symptoms

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.

Discuss side effects

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.

Stick closely to your prescription

Take your bipolar medication as it’s prescribed to you. Always follow your HCP’s exact instructions. 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, and focus on getting adequate sleep, eating a healthy diet, and finding strategies to manage stress.

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 who specializes in diagnosing and treating bipolar disorder.