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Written by the OrganizedWisdom Team with as the reviewer. All original content is supervised by the The OrganizedWisdom Medical Review Team
My doctor won't prescribe an antidepressant, isn't depression part of bipolar?
Answered by:
Diplomate, American Board of Psychiatry and Neurology
In addition to “switching” and “rapid cycling” more subtle destabilizing effects are possible as antidepressants may make it more difficult to get a good outcome from an otherwise effective mood stabilizer treatment. There is even a concern that antidepressants may permanently alter the course of a person's bipolar illness, through a phenomenon called "kindling." Data strongly suggests that the use of standard antidepressant medication in combination with mood stabilizers in bipolar patients is no more effective than the use of mood stabilizers alone. Therefore, considerable caution should be used before starting an antidepressant in a patient with bipolar disorder.
Although depression is very much part of bipolar disorder, the conservative approach for the treatment of bipolar disorder is to first establish a mood stabilizing medication prior to beginning the antidepressant. The mood stabilizer has the effect of moderating or opposing the mania-inducing effects of the antidepressant. Having said that there are situations where unopposed antidepressants may be acceptable, as when suicide is an imminent threat. In those cases, alternative agents, such as quetiapine or lamotrigine, should be considered. When using an antidepressant, your doctor may prescribe an SSRI or buproprion (Wellbutrin) rather than a TCA or venlafaxine (Effexor) as a first-line treatment.
Dr. Padder is a diplomate of the American Board of Psychiatry and Neurology. He is currently medical director of two mental health clinics in Columbia, Maryland, and a consulting psychiatrist at Howard County General Hopsital, an affiliate of Johns Hopkins Medicine. Write to Dr. Padder at tanveerpadder@gmail.com.
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