Bipolar Disorder

To treat depression in persons with bipolar disorder, psychiatrists may prescribe antidepressants. Generally, the use of antidepressants is limited to treatment during depressive episodes. Once the depressive episode has lifted, the antidepressant gradually is decreased.

These medicines aim to correct chemical abnormalities in the brain that may be responsible for the depressive symptoms of the illness. They are usually used in conjunction with a mood stabiliser.

There are various types of antidepressants:

Monoamine oxidase inhibitors (MAOIs) (eg phenelzine and moclobemide)

MAOIs work by preventing the natural breakdown of serotonin and noradrenaline by a chemical called monoamine oxidase. This leaves more of these chemicals active in the brain and in this way helps relieve depression.

selective serotonin re-uptake inhibitors (SSRIs) (eg citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline)

SSRIs are the newest type of antidepressant. They work by preventing serotonin being absorbed back into the nerve cells. This prolongs the mood-lightening effect of any released serotonin and so helps to relieve depression.

Tricyclic antidepressants (TCAs), (eg amitriptyline, dothiepin, imipramine and lofepramine)

TCAs work by preventing both noradrenaline and serotonin being absorbed back into the nerve cells, with the same mood-lifting effect. Trazodone is related to the TCAs.

others that do not quite fit neatly into these groups, but that have effects similar to one or more of them, eg venlafaxine, mirtazepine, reboxetine and trazodone hydrochloride.

All antidepressants take between two and eight weeks to start having an effect. This means you need to keep taking them, even if they don’t seem to make much difference in the beginning.

There is no general consensus on the length of antidepressant treatment that is appropriate for bipolar depression.

Some people may need to stop the antidepressant as soon as they recover from the depressive episode, but others may have to continue on it longer, maybe even for months. This usually depends on how you have previously responded to antidepressants.