Antidepressants in Bipolar Disorder: The Controversies

There are at least 9 alternatives with at least as much evidence as antidepressants for effectiveness in bipolar depression, that don’t make bipolar disorder worse, as is clearly a risk with antidepressants. So most of these questions are nearly moot, in my opinion. Just skip the antidepressants unless you’re backed into them by not getting better on less potentially risky stuff.  But that’s not widely agreed upon, even after 10 years of direct study. Here are the specific areas of controversy.

  1. Do antidepressants even work in bipolar depression? Yes, but it’s not very well, except perhaps in Bipolar II, depending on who you listen to. 
  2. Can antidepressants trigger manic symptoms? Yes, that’s completely agreed upon. But how often? That’s not agreed upon at all.
  3. Are antidepressants “mood de-stabilizers” ? This is a crucial question, at least as important as #2. Answer: uh, it’s complicated?
  4. If you’re on an antidepressant and doing well, should you stay on or taper off?  First, don’t do anything without talking with whoever prescribed it.  If you have more than 4 mood episodes per year — then maybe taper off? Careful here!

(updated 10/2020)