Antidepressants for Bipolar Depression


Antidepressants play an important role in the treatment of bipolar disorder. Bipolar depression, left untreated, can have serious consequences. While many mood stabilizers have antidepressant properties, the mood stabilizer alone may not be enough to deal with a depressive episode, which is where antidepressants come in.
But caution must always be used when a person with bipolar disorder begins taking an antidepressant, as these drugs may cause mania or hypomania. In fact, many people who seemed to be suffering from major depressive disorder were diagnosed with bipolar disorder instead after experiencing a manic or hypomanic episode that was triggered by the antidepressant prescribed for their depression.

All antidepressants approved for use in the United States are required to have a black box warning in the patient prescribing information given to doctors regarding the possibility of suicidal thinking and behavior in children and young adults who take these drugs.

There are several classes of antidepressants. Here is a look at each one, with links to in-depth content.

SSRI Antidepressants

SSRI stands for selective serotonin reuptake inhibitor. Serotonin is one of the chemicals in the brain that affects mood. SSRI antidepressants, which are neurotransmitters, allow more serotonin to be available in the spaces between nerves, which has been shown to ease depression in some patients. See Messengers of the Brain for an explanation of how drugs that inhibit reuptake - the SSRIs and SNRIs (below) - work to help depression.
SSRIs for Bipolar Depression
SNRI Antidepressants

SNRI stands for serotonin norepinephrine reuptake inhibitor. Like serotonin, norepinephrine is a neurotransmitter that can affect mood, and it is also a hormone that has other properties. SNRI antidepressants work to allow both more serotonin and more norepinephrine to be available in the brain.
SNRIs for Bipolar Depression
Tricyclic Antidepressants

The tricyclic antidepressants are older than the SSRIs and SNRIs. They were named for their chemical structure. These drugs also work to block reuptake of serotonin and/or norepinephrine. Some of the tricyclics also have other uses, such as improving the quality of sleep or the treatment of diabetic neuropathy.
Tricyclic Antidepressants for Bipolar Depression
MAOI Antidepressants

Monoamine Oxidase Inhibitors - commonly known as MAOIs - were the second type of antidepressants developed, after the tricyclics. Because of the way they work, MAOIs have significant dietary restrictions and important limitations on what other drugs may be taken at the same time. Thus they are not considered to be the drugs of first choice when treating depression.
MAOIs for Bipolar Depression
Atypical Antidepressants

Atypical antidepressants are called "atypical" because they are chemically unrelated to the other classes of antidepressants listed above. The drugs in this class all operate differently - in some cases the mechanism isn't exactly known - and some have additional uses beyond the treatment of depression.

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