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Antidepressants and Bipolar Disorder: The Controversy
DISCLAIMER: The following article should not be regarded as authoritative; it is simply the personal experience of the author and the result of recent controversy: Antidepressants are one of the major medication classes used in the treatment of Bipolar Disorder; however, recently antidepressants prescribed along with mood stabilizers for bipolar patients have come under controversy. This controversy centers around the accusation that antidepressants cause patients with Bipolar Disorder to go into an episode of bipolar mania, and/or rapid cycling Bipolar Disorder. Patients who present simply complaining of depression will, most likely, first be prescribed an antidepressant medication rather than a mood-stabilizer; however, in patients with true Bipolar Disorder, rather than simply depression, this frequently will cause the patient to go into a bipolar manic episode. In treatment for Bipolar Disorder, the conservative approach is to first prescribe a mood stabilization medication prior to prescribing an antidepressant. If an antidepressant is then prescribed, the mood stabilizing medication should have the effect of moderating, or opposing, the antidepressant’s mania-inducing effects. The recent controversy arises over the issue of whether the antidepressant, in fact, "cancels out" the effect of the mood stabilizer. Those in opposition to antidepressant use with patients who have Bipolar Disorder believe that antidepressant agents have been linked with the emergence of manic episodes in bipolar patients. The study of this issue, however, is complicated by the fact that bipolar patients who already suffer with depressive episodes run a baseline risk of switching to manic episodes. Of further concern are reports of the association between antidepressant use and the development of rapid-cycling Bipolar Disorder. Because of antidepressant use reportedly causing rapid-cycling Bipolar Disorder and/or bipolar manic episodes, it has also been hypothesized that use of antidepressants in bipolar patients may worsen the overall course of Bipolar Disorder in patients in whom mood stabilization medication is being prescribed. Antidepressants have classically been prescribed for use in patients who present with anxiety. Basically, there are two ways to have anxiety with Bipolar Disorder. The first is as a symptom of the bipolar itself. Although anxiety is not clinically recognized as a symptom of Bipolar Disorder, it does present itself in the forms of agitation and irritability, which are symptoms of bipolar mania, and for which an antidepressant is usually prescribed. The second is to have anxiety as a separate condition, in which case its symptoms will not improve when the bipolar symptoms improve, which is going to require a separate treatment. And that really complicates things, because then the usual prescribed medication is antidepressants—and antidepressant medications in a patient with Bipolar Disorder, according to recent controversy, can make the bipolar worse! Antidepressants prescribed for the bipolar patient is still surrounded by controversy. Some people with Bipolar Disorder are more sensitive than others. For some bipolar patients, there is no problem with taking both a mood stabilizer along with antidepressants; for others, taking antidepressants has had a negative effect, causing them to have rapid-cycling Bipolar Disorder and/or a bipolar manic episode. Research is still being done on the issue, and to date there is no conclusion to the controversy. About the Author Michele Soloway has dealt with bipolar disorder from a very young age. Her grandmother, mother, herself, and her teenage son all have the disorder. She also lost her sister to suicide because of bipolar disorder. Michele has a blog for bipolar survivors at http://bipolarsurvivor.blogspot.com, and is also a contributing writer to www.bipolarcentral.com. Back to Article List |
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