Bipolar disorder treatment: Do antidepressants help or hurt?

What role do antidepressants play in bipolar disorder treatment? Is it true they can worsen symptoms?

- Jen / Texas

Answer

The role of antidepressants in bipolar disorder treatment remains somewhat controversial.

There is some concern that treating a person with bipolar disorder who is in a depressed phase with an antidepressant alone may transform that depression into mania with potential adverse consequences, such as a suicidal behavior. In addition, certain antidepressants may carry a greater risk of this than do others.

For these reasons, some psychiatrists have been very cautious in the use of antidepressants in people with bipolar disorder. Instead, they have opted to use antidepressants in combination with mood stabilizers or to not use antidepressants and to use mood stabilizers alone or in combination with neuroleptic drugs approved for bipolar disorder treatment.

Trying to determine who may react negatively to antidepressants is difficult and generally depends on the individual. Risk factors that may increase the risk of a negative reaction include genetic changes in the serotonin transporter gene, concurrent substance abuse, prior treatment failure with antidepressants, and so-called "rapid cycling" forms of the illness. However, some psychiatrists believe that more conclusive research is needed before conclusions can be reached about risks of antidepressants in people with bipolar disorder.

If you suffer from depression and have bipolar disorder, it is important to work with a psychiatrist who has experience in dealing with mood disorders and can carefully assess and develop a treatment plan that meets your specific needs. If a specific medication is recommended, discuss with your doctor the potential benefits and risks of this medication.

RELATED

• Bipolar disorder treatment: A cause of hypothyroidism?
• Bipolar disorder