The National Institute of Mental Health (NIMH) states that antidepressants, like selective serotonin reuptake inhibitors (SSRIs) (sertraline, fluoxetine and paroxetine) and norepinephrine and dopamine reuptake inhibitors (NDRIs) (bupropion), may be prescribed for the depressive phase of bipolar disorder. While they are effective for treating major depression, when there are no symptoms of mania, antidepressants should be used with caution when treating bipolar disorder. Antidepressants alone can cause severe mood problems with bipolar disorder and should be combined with a mood stabilizer to prevent rapid mood cycling.
Mania Trigger
When a patient with just major depression is given an antidepressant, the medication is effective in improving her symptoms by preventing the recycling of mood neurotransmitters, thus increasing the amount of these chemicals in the brain. However, a patient with bipolar disorder also has mania, which is another mood problem that results in inflated self-esteem and risky behavior. When a bipolar patient takes an antidepressant, even if she has mainly depressive symptoms, the medication can trigger a manic episode. The rapid change in mood can make it difficult for the patient to function, especially if she does not have medication that manages the manic symptoms.
Rapid Mood Cycling
Helpguide.org notes that if a patient with bipolar disorder uses just an antidepressant for a period of time, it can result in a mood destabilizing effect. This destabilizing effect causes rapid mood cycling, where the patient has more manic and depressive episodes. As a result, the patient can be feeling depressed and hopeless, then quickly change to highly energetic with racing thoughts. Rapid mood cycling can be hard for the patient to deal with and can disrupt his life.
Suicidal Thoughts and Behaviors
The Food and Drug Administration (FDA) warns that antidepressants can cause an increase in suicidal thoughts and behaviors in patients 24 and under. While this side effect is more common in patients taking antidepressants for major depression, it may also occur in bipolar disorder patients. As a precaution, the patient should be monitored closely for any changes in behavior when starting the medication.
