Recommendations for Use of Antidepressants with Bipolar Disorder

Antidepressants and bipolar disorder, should they mix? My own experience with antidepressants has helped fuel the controversial antidepressant fire in my own life, but I was curious to see what the “professionals” had to say about it.

The International Society for Bipolar Disorders (ISBD) Task Force has just released a new set of recommendations for the use of antidepressants with bipolar patients in the American Journal of Psychiatry. The final recommendations are the result of 173 studies, and urge caution. Dr. Eduard Vieta states,

First, they shouldn’t be used in mania or in mixed episodes, they should only be used in bipolar depression in patients with a history of a good response in the past to antidepressants and no history of rapid cycling or switches into mania right away.

(Mixed episodes as well as rapid cycling and switches make me a poor candidate.)

In addition, antidepressant monotherapy (meaning taking an antidepressant alone with bipolar disorder) is not advised, neither is taking an antidepressant if you have predominantly mixed states.

Of course, I could say “tell me something I don’t already know”, but at least these people are putting it on the record and hopefully others will benefit from being spared antidepressants when they are prone to having a bad reaction.

For the entire article, go here.


9 responses to “Recommendations for Use of Antidepressants with Bipolar Disorder

  1. I am one who has tried antidepressants while in a depressed state, and they sent me right into a mixed/manic state. It was really discouraging because I could feel the presence of depression, but medication only made me worse off. I was taking my regular Lithium, Abilify, & Seroquel with it & the results were still making me too up. Thanks for sharing this. I feel it is more common an occurrence than people know.

  2. when i was at the hospital talking to some other people with a possible bipolar diagnosis, we pretty much all agreed Zoloft made us go crazy. have you or anyone else had the same experience?

    • I’ve taken several antidepressants, the first time I had manic and mixed rapid cycling with psychosis, and after that any time my doctor has tried prescribing me an antidepressant it has made me switch from depression to mania. No more antidepressants for me I’m afraid!

      • well, i wish you the best of luck. the medicine game is not a fun one, but when you win (so i’ve heard) it’s awesome 🙂

  3. I started an antidepressant a few months ago after my cycling stablised, but I kept slipping into bad depressions. It’s working alongside the Seroquel to pretty good effect, but I was definitely wary.

  4. I had the same experience. I had manic phases unlike anything prior to the antidepressants. I don’t know for sure, but I suspect the antidepressants made my rapid-cycling worse.

  5. Antidepressants, for me, have always equated an upswing into extreme mania. My doctor is prescribing Ritalin for depression and it works wonders!

  6. Thanks for so generously sharing your experience, Sarah. It’s really helpful to see how others manage this beast. Rose, I have similar experiences with my own meds. I wanted to share. I think the medication of this disorder is totally a work in progress.

    My doctor prescribed Adderall for my moderately severe depression and it worked really well. It was kind of like a cardiac defibrillator for my mood. I’m now (months later) in some sort of mixed state. I do not think it’s a result of taking Adderall. The cycling started after I hadn’t taken Adderall for awhile. Still, I’m not taking it now because I’m already feeling speedy. Klonipin usually curbs my hypomania but only for a short time. To keep this all together, I’m also on Lamictal and Lithium.

    I think there’s a workable cocktail in there, especially with the integrative techniques I use like deep breathing, meditation and Reiki, but I haven’t quite hit it yet. It works well for my husband but he’s more Bipolar I and I’m more of a cycler. I’ve also had good results with Wellbutrin rather than Adderall but it doesn’t have the same immediate, jolt me out of a coma effect.

    Needless to say, this type of pharmacopoeia needs close oversight by a really observant practitioner but overall it’s a lightweight combo–it doesn’t make me feel dull and listless like I was on anti-psychotics.

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