Antidepressant Use in Bipolar

• Clinicians prescribe antidepressant medications in conjunction with mood stabilizers (i.e.-lithium ). Antidepressant usage in bipolar disorder is considered a secondary treatment in decreasing suicidality in severe bipolar cases.
  
  

SSRIs and NDRIs

• Antidepressants such as SSRIs-Selective Serotonin Reuptake Inhibitors (Paxil, Paroxetine) and NDRIs- Norepinephrine and Depamine Reuptake Inhibitors (Wellbutrin-Buprion) appear to be the most useful in working to improve the mood in severe bipolar patients.
  
  

Tricyclic Antidepressants (Amitriptyline-Elavil)

• Tricyclic antidepressants may have serious side effects. Tricyclics work by preventing reuptake of serotonin and norepinephrine in the brain but can precipitate "manic switching" (mood cycling), agitation and suicidal ideations in patients.
  
  

Clinical Studies

• In the largest study to date for bipolar disorder, STEP-BD (Systematic Treatment Enhancement for Bipolar Disorder) after antidepressants were stopped, mood improved in refractory cycling (rapid cycling in mood) bipolar patients. Thus, the clinical evidence seems to indicate a link between antidepressant use in bipolar and co-occuring mood destabilization.
  
  

Considerations

• According to a July 1, 2008 article in Psychiatric Times, Dr's. Andrea Cipriani and John R. Geddes state that antidepressants may be effective temporarily but show no long-term benefit. Conclusions from this study also suggest antidepressants do not necessarily decrease depressive episodes or suicidality when compared to first line treatment mood stabilizers.