Antidepressants in Bipolar Disorder by Alyson Bell, MD

Bipolar depression (depression that occurs after a history of one or more manic or hypomanic episodes) is treated differently that unipolar depression (depression that occurs without a history of manic or hypomanic episodes). Bipolar treatment guidelines used to recommend antidepressants as the first line treatment of bipolar depression until 2002 when the APA (American Psychiatric Association) changed their guidelines. The change was due to studies and observational data that showed two concerns: antidepressants may not be effective in treating and preventing bipolar depression and may worsen the long-term course of the illness (cycling more often between depression and mania).

​If you are diagnosed with bipolar disorder and on an antidepressant, there may be a reason for it (for example, a mood stabilizer didn't work or you're taking it in combination with a mood stabilizer to help with residual bipolar depressive symptoms or due to a comorbid anxiety disorder). Some common examples of mood stabilizers are lithium, lamotrigine, and valproic acid. Although these medications may have side effects, they should be considered at the core of any treatment regimen for bipolar disorder.