Antidepressants for Bipolar Disorder

Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. Individuals who are prescribed antidepressants are usually required to take a mood-stabilizing medication at the same time to reduce the risk of switching from depression to mania or hypomania.

Research has found that antidepressants are effective for treating depression, but it is not clear exactly how they work. Brain chemicals called neurotransmitters (chemical messengers) are believed to regulate mood. Antidepressant medications work to increase the following neurotransmitters: serotonin, norepinephrine, and/or dopamine.

Be Patient

All antidepressants must be taken as prescribed for 3 to 4 weeks before you can expect to see positive changes in your symptoms. It is important that you don’t stop taking your medication because you think it’s not working. Give it time!

Keep Working to Find the Right Fit

Like mood stabilizers, the antidepressant you try first may not lead to improvements in mood. It may be necessary to try another medication or combination of medications. Talk to your doctor if your symptoms do not improve.

Prevent Relapse: Don’t Stop

Once you have responded to treatment, it is important to continue taking your medication to prevent your symptoms from coming back or worsening. Do not abruptly stop taking your medication, even if you are feeling better, as this may result in a relapse. Medication should only be stopped under your doctor’s supervision. If you want to stop taking your medication, talk to your doctor about how to correctly stop.

Side Effects

Like all medications, antidepressants can have side effects. In many cases, they are mild and tend to diminish with time. Many people have few or no side effects, and the side effects people typically experience are tolerable and subside within a few days. Your doctor will discuss some common side effects with you.

Check with your doctor if any of the common side effects persist or become bothersome. If you experience side effects, talk to your doctor before making any decisions about discontinuing treatment. In rare cases, these medications can cause severe side effects. Contact your doctor immediately if you experience one or more severe symptoms.

Five Classes of Antidepressant Medications

There are five different classes of antidepressant medications. This post lists antidepressant medications by class along with their common side effects.

Antidepressant Class #1: Selective Serotonin Reuptake Inhibitors (SSRI)

SSRIs are the most commonly prescribed class of antidepressants because they tend to have the fewest side effects. SSRIs increase the level of serotonin by inhibiting reuptake of the neurotransmitter.

• Fluoxetine (Prozac)
• Citalopram (Celexa)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Escitalopram (Lexapro)

Common side effects for SSRIs: Abnormal dreams; anxiety; blurred vision; constipation; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; flu-like symptoms (e.g., fever, chills, muscle aches); flushing; gas; increased sweating; increased urination; lightheadedness when you stand or sit up; loss of appetite; nausea; nervousness; runny nose; sore throat; stomach upset; stuffy nose; tiredness; trouble concentrating; trouble sleeping; yawning; vomiting; weight loss.

Antidepressant Class #2: Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)

SNRIs are similar to SSRIs in that they increase levels of serotonin in the brain. They also increase norepinephrine in the brain to improve mood.

• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Desvenlafaxine (Pristiq)

Common side effects for SNRIs: Anxiety; blurred vision; changes in taste; constipation; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; fatigue; flushing; headache; increased sweating; loss of appetite; nausea; nervousness; sore throat; stomach upset; trouble sleeping; vomiting; weakness; weight loss; yawning.

Antidepressant Class #3: Atypical Antidepressants

In addition to targeting serotonin and/or norepinephrine, atypical antidepressants may also target dopamine. They also tend to have fewer side effects than the older classes of medication listed below (Antidepressant Classes 4 and 5). The common side effects differ for each of the medications in this class of antidepressants.

• Bupropion (Wellbutrin)
  Common side effects: Constipation; dizziness; drowsiness; dry mouth; headache; increased sweating; loss of appetite; nausea; nervousness; restlessness; taste changes; trouble sleeping; vomiting; weight changes.
• Mirtazapine (Remeron)
  Common side effects: Constipation; dizziness; dry mouth; fatigue; increased appetite; low blood pressure; sedation; weight gain.
• Trazodone (Desyrel)
  Common side effects: Blurred vision; constipation; decreased appetite; dizziness; drowsiness; dry mouth; general body discomfort; headache; light-headedness; muscle aches/pains; nausea; nervousness; sleeplessness; stomach pain; stuffy nose; swelling of the skin; tiredness; tremors.
• Nefazodone (Serzone)
  Common side effects: Abnormal dreams; abnormal skin sensations; changes in taste; chills; confusion; constipation; decreased concentration; decreased sex drive; diarrhea; dizziness; drowsiness; dry mouth; fever; frequent urination; headache; incoordination; increased appetite; increased cough; indigestion; lightheadedness; memory loss; mental confusion; ringing in the ears; sleeplessness; sore throat; swelling of the hands and feet; tremor; urinary retention; urinary tract infection; vaginal infection; weakness.

Antidepressant Class #4: Tricyclics and Tetracyclics (TCA and TeCA)

This is an older class of antidepressants that also work by increasing levels of serotonin and norepinephrine in the brain. These medications are good alternatives if the newer medications are ineffective.

• Amitriptyline (Elavil or Endep)
• Amoxapine (Asendin)
• Clomipramine (Anafranil)
• Desipramine (Norpramin or Pertofrane)
• Doxepin (Sinequan or Adapin)
• Imipramine (Tofranil)
• Nortiptyline (Pamelor)
• Protriptyline (Vivactil)
• Trimipramine (Surmontil)
• Maprotiline (Ludiomil)

Common side effects for the TCAs: Abnormal dreams; anxiety or nervousness; blurred vision; change in appetite or weight; changes in blood pressure; change in sexual desire or ability; clumsiness; confusion; constipation; decreased memory or concentration; dizziness; drowsiness; dry mouth; excess sweating; excitement; headache; heartburn; indigestion; nausea; nightmares; pounding in the chest; pupil dilation; restlessness; sleeplessness; stuffy nose; swelling; tiredness; tremors; trouble sleeping; upset stomach; urinary retention; vomiting; weakness.

Antidepressant Class #5: Monoamine Oxidase Inhibitors (MAOI)

MAOIs are an older class of antidepressants that are not frequently used because of the need to follow a special diet to avoid potential side effects. However, these medications can be very effective. These drugs work by blocking an enzyme called monoamine oxidase, which breaks down the brain chemicals serotonin, norepinephrine, and dopamine.

When taking MAOIs, it is important to follow a low “tyramine” diet, which avoids foods such as cheeses, pickles, and alcohol, and to avoid some over-the-counter cold medications. Most people can adopt to a low tyramine diet without much difficulty. Your doctor will provide a complete list of all food, drinks, and medications to avoid.

• Phenelzine (Nardil)
• Tranylcypromine (Parnate)
• Selegiline (Emsam) patch

Common side effects for MAO/MAOIs: Blurred vision; changes in sexual function; diarrhea, gas, constipation, or upset stomach; difficulty swallowing or heartburn; dizziness, lightheadedness or fainting; drowsiness; dry mouth; headache; nausea, muscle pain or weakness; purple blotches on the skin; rash, redness, irritation, or sores in the mouth (if you are taking the orally disintegrating tablets); sleeping problems; stomach pain, tiredness; tremors; twitching; unusual muscle movements; vomiting, unusual dreams; upset stomach; weakness.

Here are some additional articles you might find helpful:

• What Causes Bipolar Disorder
• Bipolar Disorder: The Symptoms
• Evidence-Based Treatments for Bipolar Disorder 
• Bipolar Disorder Medication: What You Should Know
• Mood Stabilizers for Bipolar Disorder: What You Should Know
• Antipsychotic Medication for Bipolar Disorder: What You Should Know