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

Image: ©alexlmx2016 – stock.adobe.com

The post All antidepressants appeared first on NeuRA Library.

Even though antidepressants are effective for treating depression, their use in people with bipolar disorder can increase the risk of phase shifting from depression to mania. Most antidepressants increase serotonin or noradrenaline; in contrast, bupropion has unique pharmacokinetics as a norepinephrine-dopamine reuptake inhibitor. Therefore, it has been suggested that bupropion may have benefits for depression with less risk of phase shifting than other antidepressants.

What is the evidence for bupropion as treatment for bipolar disorder?

Moderate to low quality evidence suggests a large effect of greater improvement in depression scores with bupropion than with placebo. There were no differences between bupropion and other antidepressants for depression or phase-shifting.

November 2021

Image: © molekuul.be – stock.adobe.com

The post Bupropion appeared first on NeuRA Library.

Fluoxetine is a widely prescribed antidepressant due to its efficacy and safety profile. It is a selective inhibitor of serotonin reuptake and has little effect on other neurotransmitters. It is often prescribed for bipolar disorder along with the antipsychotic olanzapine.

What is the evidence for fluoxetine as treatment for bipolar disorder?

Moderate to high quality evidence suggests greater improvement in depression with combined olanzapine and fluoxetine when compared to placebo, olanzapine or lamotrigine alone. Low quality evidence is unable to determine the benefits or risks of fluoxetine alone.

November 2021

Image: ©MaZi – stock.adobe.com

The post Fluoxetine appeared first on NeuRA Library.

Imipramine is a tricyclic antidepressant that is widely prescribed for both depression and anxiety. It works by increasing levels of serotonin and norepinephrine and by blocking certain serotonin, adrenergic, histamine, and cholinergic receptors.

What is the evidence for imipramine as treatment for bipolar disorder?

Low quality evidence is unable to determine the benefits of imipramine for bipolar disorder.

Review authors conclude that the existing evidence does not support the use of imipramine for bipolar disorder.

November 2021

Image: ©Unkas Photo- stock.adobe.com

The post Imipramine appeared first on NeuRA Library.

Paroxetine is a selective serotonin reuptake inhibitor that is widely prescribed for both depression and anxiety.

What is the evidence for paroxetine as treatment for bipolar disorder?

Moderate to low quality evidence suggests no benefits of paroxetine over placebo for bipolar disorder. Low quality evidence is unable to determine the benefits of paroxetine over other medications.

Review authors conclude that the existing evidence does not support the use of antidepressants in general for people with bipolar disorder.

November 2021

Image: ©lyricsai- stock.adobe.com

The post Paroxetine appeared first on NeuRA Library.

Phenelzine is a non-selective and irreversible monoamine oxidase inhibitor that is often prescribed for both depression and anxiety.

What is the evidence for phenelzine as treatment for bipolar disorder?

Low quality evidence is unable to determine the benefits of phenelzine over placebo or lamotrigine for bipolar disorder.

November 2021

Image: ©motortion – stock.adobe.com

The post Phenelzine appeared first on NeuRA Library.

Sertaline is a selective serotonin reuptake inhibitor that is widely prescribed for both depression and anxiety.

What is the evidence for sertraline as a treatment for bipolar disorder?

Moderate to low quality evidence suggests no differences in rates of switching to mania between sertraline and bupropion or venlafaxine.

November 2021

Image: ©Alon Harel – stock.adobe.com

The post Sertraline appeared first on NeuRA Library.

Tranylcypromine is a monoamine oxidase inhibitor. It is widely used to treat both depression and anxiety.

What is the evidence for tranylcypromine as a treatment for bipolar disorder?

Low quality evidence is unable to determine the benefits of tranylcypromine for bipolar disorder.

Review authors conclude that additional research is required to establish the efficacy of tranylcypromine as an add on to a mood stabiliser.

November 2021

Image: ©cassis – stock.adobe.com

The post Tranylcypromine appeared first on NeuRA Library.

Venlafaxine is a selective serotonin reuptake inhibitor that is widely prescribed for both depression and anxiety.

What is the evidence for venlafaxine as a treatment for bipolar disorder?

Moderate to low quality evidence suggests no differences in rates of switching to mania between sertraline and bupropion or venlafaxine.

November 2021

Image: ©areeya_ann – stock.adobe.com

The post Venlafaxine appeared first on NeuRA Library.