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Expert Q&A

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Can antidepressants jump-start bipolar disorder?

Asked by Michelle, Michigan

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I had an untreated health issue for a couple of years that threw me into a mild depression. I have a mother and brother who are bipolar and one of the things my therapist told me is that studies show that if you go on an antidepressant and there is a history of bipolar in your family that this can sometimes "kick in" the bipolar. I am lucky and was able to get past my depression with therapy, exercise, etc. I was just wondering what your thoughts were.

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Michelle,

I've got a lot of thoughts about your question, and they are all confused! In this way I am much like the field of psychiatry as a whole. Ten years ago I would have told you that what you'd heard was absolutely correct and that people with bipolar disorder should avoid antidepressants because of the risk these medications pose in terms of making vulnerable people manic.

I still mostly believe this, but a number of large studies done over the last five years do not do much to confirm the idea that antidepressants are dangerous for people with -- or at risk for -- bipolar disorder. In these studies, people with bipolar disorder seem able to take antidepressants and not "go manic" at any higher rate than they would have naturally.

On the other hand, anyone who has practiced psychiatry for any time at all can tell you stories of people like yourself with a bipolar family history who went manic soon after going on an antidepressant for the first time. So what's the truth? We just don't know.

In fact, we don't even know whether antidepressants help people with bipolar disorder who get depressed. It's interesting. Studies done on the East Coast of the United States tend to find that antidepressants do not help, whereas studies done on the West Coast suggest that they are of tremendous benefit. What's the truth? We just don't know yet.

There are a few things I think we can say with at least a little certainty. First, we know that people from families with bipolar disorder are twice as likely to have "regular old" depression than to have classic bipolar disorder. Like everyone else, these folks should have their depression treated as rapidly and completely as possible, and antidepressants are often hugely useful in accomplishing this. On the other hand, there is at least some evidence that people with family histories like yours may be at an increased risk of having a manic episode on an antidepressant. This wouldn't stop me from using one, but I'd watch with extra caution. The good news is that you tapped into other well documented antidepressant strategies, including exercise and psychotherapy.

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