IF I have bipolar, can I take antidepressant drugs?

As a rule anti depressants are almost never used to treat bipolar disorder. It is only the rare physician who treats bipolar with an antidepressant. The reason for the hesitancy in treating a bipolar patient who is depressed with a conventional anti depressant is that the drug may rapidly induce a state of mania with potential adverse outcomes, such as extreme paranoia, suicide or psychosis.

Further, not all anti depressants work in the same way and there is always a chance of harming the patient. For the above reasons most psychiatrists have been very hesitant in using the conventional anti depressant in individual with a bipolar disorder. The routine practice has been to use an anti depressant in combination with a mood stabilizer to prevent the sudden onset of mania. Some physicians only use a mood stabilizer alone or combine it with a anti psychotic (neuroleptic) drugs which is approved for use in bipolar depression.

At the moment there is no way of knowing which bipolar individual will react adversely to the anti depressant drugs. Most of the factors which determine the type of reaction are individually based. Individuals who continue to abuse drugs, or have had prior treatment failures with anti depressant, or those who have a rapid cycling form of bipolar disorder or those with a genetic alteration a certain gene (serotonin transporter gene) have a high risk of developing adverse reactions.

So far there are no rigid rules or guidelines as to when an anti depressants can be used in patients with bipolar disorder. In those individuals with bipolar disorder who continue to have prolonged episodes of depression, it is important to discuss this issue with your mental health counselor. One needs to develop a treatment plan to meet individual needs. If an anti depressant is started, one needs very close follow up to ensure that there are no untoward problems during the with mania phase.