The Big Three for Bipolar Depression

Table of Contents

If you have enough bipolarity, it’s best to avoid antidepressants. Or perhaps you’ve had a couple of antidepressants and things didn’t go well, and you’re looking for an antidepressant approach using a mood stabilizer . Which medications should you consider?

In reviews of this question, and treatment guidelines from around the world, the “big three” that come up over and over are (check marks mean the medication was listed as a main choice for treatment of bipolar depression):


No lurasidone/Latuda?  It’s too new. Thus it’s much more expensive, and it will be a few years before we know what it really does. What risks does it carry? that takes a couple years at least to really know.

So, that leaves the Big Three. How do you choose?

  1. What works the best?
  2. What has the fewest side effects?
  3. What has the fewest risks?

You can imagine: it’s a balance between these three. Some people might be desperate and want the one with the best evidence for effectiveness. Some people might recognize that they’ve been dealing with these symptoms for years and will likely take this medicine for years, so they want the one with the fewest long-term risks. Others will be afraid of having side effects (that’s most folks).

And so the result is at attempt to consider each of these three main options from your point of view, looking at your needs. Your doc’ or NP might say “this is the one for you” but hopefully she or he will have thought that through based on these three factors. Read some more about each one so you can participate as a well-informed patient,  in that discussion.

  • lithium: it’s a much better option than you think
  • lamotrigine: it’s my usual first choice (low risks, no side effects for most people
  • quetiapine/Seroquel: really strong evidence for effectiveness (and maybe the strong sleepiness at night would be a good thing in your case; but weight gain is the big problem)

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