Bipolar Disorder - When Not To Take Antidepressants

We generally do not use antidepressants in bipolar 1 disorder, because antidepressants are more likely to cause you to switch from depression into mania thereby triggering mania. Or it can cause you to rapid cycle. That is, you can have a depressed state that resolves and then quickly returns. A quick return would be within weeks. So when you hear the term switching and antidepressants causing switching, it's classically meant as switching between mania and depression but it can also refer to rapidly returning episodes. Even if it was the same episode.

With bipolar 2 disorder you get hypomania and depression instead of mania and depression. But the depression in bipolar 2 tends to be longer and more severe. In general we believe that people with bipolar 2 disorder can safely take antidepressants especially if it is added to a mood stabilizer. And there are some subgroups of people who can tolerate an antidepressant without a mood stabilizer, which is called monotherapy. We don't have a clear picture though of what subgroup of people can handle antidepressants well. But it may be related to how you experience your hypomania.

Here are some risk factors for antidepressants making you more unstable or causing switching:
Having bipolar I disorder as opposed to bipolar 2
Having mixed features during depression
Using tricyclics antidepressants like nortriptyline or amitryptline.

Video on Mixed Mania
https://youtu.be/Nw-1NEwarUg

References:
Gitlin M. Antidepressants in bipolar depression: an enduring controversy. Int J Bipolar Disord (2018) 6:25

Simon NM, Otto MW, Fischmann D, Racette S, Nierenberg AA, Pollack MH, Smoller JW. Anxiety sensitivity as a potential mediator of panic during manic states. J Affect Disord. 2005 Jul; 87(1):101-5.

Parker G, Ed. Bipolar II Disorder: Modelling, Measuring, and Managing, 3rd ed. Cambridge, UK: Cambridge University Press; 2019.

Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice from me to you. Watching the videos or getting answers to comments/question, does not establish a doctor-patient relationship. If you have your own doctor, perhaps these videos can help prepare you for your discussion with your doctor.

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Видео Bipolar Disorder - When Not To Take Antidepressants канала Dr. Tracey Marks