Antidepressants and Bipolar Disorder

A current controversy in the treatment of bipolar disorder is how antidepressant medication(s) should be used to treat symptoms. A recent research article in the New England Journal of Medicine stated that “The use of adjunctive, standard antidepressant medication, as compared with the use of mood stabilizers, was not associated with increased efficacy.” In other words, antidepressant medication did not help these patients over the longer term. This study also reported that taking antidepressants was not associated with “increased risk of treatment-emergent affective switch,” that is, they did not trigger the development of manic or mixed symptoms, either. However, the patients in this study were only followed for about 6 months. In another study, which followed patients for one year, antidepressants were found to raise the risk of a switch to mania or hypomania. This is more in line with my clinical experience, which is that antidepressants often cause more cycling in patients with bipolar disorder and can induce mild mixed states where people have bouts of “rage” and irritability. Some patients describe these symptoms as “anxiety,” but close questioning often reveals the tense, “wired,” pressured feelings of a mixed state.