Table of Contents
Lithium or lamotrigine (Lamictal, generic) are usually the first choiced for treating depressive episodes in bipolar disorder. Antidepressants are sometimes used, but their use is controversial. They may trigger mania in 10 - 30% of patients. In addition, a number of studies report no additional benefits from antidepressants. Specific antidepressants may be beneficial in certain circumstances. However, any patient on antidepressants who develops symptoms of hypomania should stop taking these drugs (under the care of a doctor), since hypomania is often a sign of impending mania. All antidepressants should be tapered off after the mood has been stabilized for a month.
Bupropion. The antidepressant bupropion (Wellbutrin, generic) appears to pose a lower risk for triggering mania than do other antidepressants. Side effects may include restlessness, agitation, sleeplessness, headache, rashes, stomach problems, and in rare cases, hallucinations and bizarre thinking. Bupropion has also been associated with changes in behavior, hostility, agitation, and suicidal thoughts and behaviors. Initial weight loss occurs in about 25% of patients. High doses may cause seizures. This side effect is uncommon and tends to occur in patients with eating disorders (anorexia or bulimia) or those with risk factors for seizures.
Selective Serotonin Reuptake Inhibitors. Serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, generic), citalopram (Celexa, generic), sertraline (Zoloft, generic), and paroxetine (Paxil, generic), are sometimes used to treat bipolar depression, but their benefits have not yet been established. They may be useful in patients whose depression does not respond to lithium. They do not appear to be useful as an add-on treatment to lithium. Another antidepressant, venlafaxine (Effexor, generic), may also be used in patients with severe cases of depression who do not respond to other treatments.
Side effects of SSRIs may include:
- Nausea and gastrointestinal problems, which usually wear off over time
- Agitation, insomnia, mild tremor, and impulsivity
- Dry mouth, which can increase the risk for cavities and mouth sores
- Headache
- Sexual dysfunction
Monoamine Oxidase Inhibitors (MAOIs). Older antidepressants known as monoamine oxidase inhibitors (MAOIs), may sometimes be used for bipolar depression. MAOIs can interact with certain foods and cause severe high blood pressure. Such foods have high tyramine content and include aged cheeses, most red wines, vermouth, dried meats and fish, canned figs, fava beans, and concentrated yeast products. MAOIs can also have severe interactions with certain drugs, including some common over-the-counter cough medications. In such cases, severe high blood pressure or dangerous reactions can occur. It is important that patients discuss with their doctor any other medications they are taking.
[For more information on antidepressant medications, see In-Depth Report #08: Depression.]
Review Date: 01/28/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
