The treatment of bipolar disease with coexisting depression can be complicated due to the fact that all antidepressants have tendencies to cause mania and induce mixed states and/or mood cycling. This can cause deterioration of the long-term disease process. Physicians currently attempt to treat bipolar depression without antidepressants, even adding a second anti-manic medication before resorting to antidepressant agents. In the event of rapid cycling mood with depression, or depression that is occurring at the same time with mixed mania states, the standard of treatment is to cease antidepressant use and rely on anticonvulsant therapy to bring the disease process under control.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Short-acting SSRIs such as sertraline or paroxetine are among the first choices when antidepressants are utilized in bipolar depression. They are less likely to induce mania/hypomania than tricyclic antidepressants (TCA) or monoamine oxidase inhibitors (MAOIs).
Bupropion
Bupropion is also one of the first antidepressants chosen to treat bipolar depression. However, it has been shown to result in mania in a few patients and also serves to lower the seizure threshold in many of its users; all of which is weighed by a clinician before deciding to utilize it.
Monoamine Oxidase Inhibitors (MAOIs)
These are typically called into action when SSRI/Bupropion therapy is ineffective. Their main benefit is in patients with negative or atypical symptoms such as anergia, increased appetite, increased sleep and fatigue, where they have been shown to be particularly efficacious.
References
- "Psychiatric Secrets, 2nd Edition;" Jacobson; 2001
- "Massachusetts General Hospital Comprehensive Clinical Psychiatry, 1st Edition;" Stern; 2008
- "Primary Care: Clinics in Office Practice;" Bipolar Spectrum Disorder: Differential Diagnosis and Treatment; Muzina, D.; Volume 34, Issue 3 (September 2007)
