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What are antidepressants for bipolar depression?

Most antidepressants increase serotonin or noradrenaline, and are effective for the treatment of unipolar depression. However, as they may increase the risk of phase shifting from depression to mania in people with bipolar disorder, they are generally used only when the depressive phase is severe and shows poor response to mood stabilisers or antipsychotics.

What is the evidence on antidepressants for bipolar depression?

Moderate to high quality evidence suggests second generation antidepressants (with or without mood stabilisers), are a more effective long-term prophylactic treatment for relapse to depression than placebo (with or without mood stabilisers). Moderate to low quality evidence suggests no differences in relapse rates to depression or mania between antidepressants and mood stabilisers.

Moderate quality evidence suggests ~19% of people with bipolar depression taking antidepressants switch to mania. Switching rates are highest in people with a family history of affective disorders, previous suicide attempts, depression polarity of the index episode, lifetime psychotic features, and rapid- cycling course. Rates were lowest in people taking antidepressants with concurrent lithium.

November 2021

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Last updated at: 2:00 pm, 15th February 2022
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