• Depression

Studies show controversy on use of antidepressants for bipolar depression

Bipolar disorder, a sometimes debilitating illness marked by severe mood swings between depression and mania, is usually treated with mood stabilizers such as lithium, valproate, carbamazepine or other medications that reduce mania. However, depression is more common than mania in bipolar disorder, and depressive episodes tend to last longer than episodes of mania.

Treating depression in people with bipolar disorder is notoriously difficult,” says Thomas R. Insel, director of the National Institute of Mental Health (NIMH). Antidepressant medications are often used in addition to a mood stabilizer for treating bipolar depression. But, two recent studies suggest that antidepressants, used alone or in combination with mood stabilizers, aren’t effective for bipolar depression. An NIMH-funded study found that a combination of antidepressants and mood stabilizers is safe, but no more effective than a placebo – a sugar pill. A study published in the medical journal Australian Prescriber found that antidepressants used alone not only aren’t effective, but can cause a switch from a depressive episode to a manic episode.

Careful management of mood stabilizer medications is a reasonable alternative to adding an antidepressant medication for treating bipolar depression, according to researchers of the NIMH study, the large-scale, multi-site Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). In addition, education, self-monitoring of mood and mood diaries, involvement of family members and information about lifestyle changes can help patients get better and stay well longer, said the authors of the Australian Prescriber article. “Good communication and rapport between doctor and patient is particularly important in fostering compliance with treatment,” they said.

For bipolar II patients with major depression, the story may be different. While standard treatment has included mood stabilizers alone or combined with antidepressants as for bipolar I, some recent studies have found that, for bipolar II depression, the antidepressant Venlafaxine (Effexor, Efexor), used alone, could be an effective initial therapy with a low hypomanic switch rate.

The use of antidepressants for bipolar disorder remains controversial.

Health professionals should consider the diagnosis of bipolar disorder in patients with treatment-resistant or recurrent depression, says Dr Ajeet Singh, University of Melbourne, coauthor of the study.

Starting, switching, stopping meds Playing pharmacology roulette can be dangerous

Living with depression, anxiety or bipolar disorder can mean starting and changing medications. And that can cause side effects if not done as directed by your doctor. Starting a new medication or discontinuing one is often done a little at a time. If you’re switching medications, you may gradually decrease the old drug, while increasing to the recommended dose of the new, overlapping the two for a time during the transition. If you discontinue a drug too abruptly, your symptoms could worsen and you could suffer side effects. Starting some drugs without gradually increasing the dose can also cause problems.

Sometimes, a person taking an antidepressant will decide they feel better and no longer need their medication or they want to quit it because of side effects. Perhaps the medication doesn't seem to be helping. Talk about these issues with your doctor. You may want to give it a little more time or there may be a medication that will work better for you. Your doctor might want to reconsider your diagnosis. For example, some people whose depression doesn't get better or gets worse on antidepressants may have bipolar disorder and should be treated with different medications. But whatever the reason for stopping or switching, ask about side effects and let your doctor give you a schedule for doing it safely and effectively.

What side effects can accompany starting, switching, stopping drugs?

Different kinds of medications carry different risks when started or stopped

Bipolar disorder