Are antidepressants safe for individuals who have bipolar disorder?

A subset of people who have bipolar depression appear to benefit from antidepressants. This happens when they are combined with mood stabilizers or atypical antipsychotics for bipolar depression. However, in general this is not considered a first-line strategy.

When you add antidepressants to adjuvant mood stabilizers or atypical antipsychotics, the risk of treatment-emergent affective switch is similar to placebo in the short-term.

You should avoid antidepressants:

• in people who have a history of antidepressant-induced mania or hypomania.
• for those with recent rapid cycling.
• for those with current mixed features.
• as monotherapy for people with Bipolar I disorder.

Learn more about common myths around SMI and psychopharmacology. See our infographic on this topic.

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REFERENCES

• Gitlin MJ. Antidepressants in bipolar depression: an enduring controversy. International journal of bipolar disorders. 2018;6(1):25.
• Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97-170.
• McGirr A, Vöhringer PA, Ghaemi SN, Lam RW, Yatham LN. Safety and efficacy of adjunctive second-generation antidepressant therapy with a mood stabiliser or an atypical antipsychotic in acute bipolar depression: a systematic review and meta-analysis of randomised placebo-controlled trials. The Lancet Psychiatry. 2016;3(12):1138-46.
• Pacchiarotti I, Bond DJ, Baldessarini RJ, Nolen WA, Grunze H, Licht RW, et al. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. The American journal of psychiatry. 2013;170(11):1249-62.