A Fine Line: Bipolar Depression Treatment and Antidepressants

There’s a world of antidepressants out there that can elevate mood, decrease emotional suffering, lift you out of fatigue and lethargy, and return you to the world of function and productivity. SSRIs, SNRIs, bupropion, MAOIs, tricyclics–there is a virtual pharmaceutical smorgasbord of options for people with depression to choose from. And yet if your depression is accompanied by the manic or hypomanic episodes of bipolar disorder, it is likely that you cannot benefit from any of them. In fact, antidepressants can deepen your instability and endanger your psychological health, sometimes making them incompatible with bipolar depression treatment.

Unipolar and bipolar depression may look and feel the same to you, but research is increasingly showing significant differences in how they affect the brain and, in turn, highlighting the need for unique interventions that safely address the specific qualities of each depression type. Using neuroimaging technology, researchers from the University of Pittsburgh Medical Center have found that the emotional center of the brain–the amygdala–communicates differently with the cognitive and behavioral control center–the prefrontal cortex–in people with bipolar depression.  They also discovered that people with bipolar depression have decreased blood flow to the anterior cingulate gyrus region of the prefrontal cortex, which regulates emotions, empathy, decision-making, and impulse control. Research is ongoing, but these differences may begin to explain why antidepressants are often ineffective at combating bipolar depression; the chemical changes brought about by current antidepressants may not correct the unique brain activity caused by this type of mood disturbance.

Despite lack of clear therapeutic evidence, clinicians continue to prescribe antidepressants to people with bipolar disorder, sometimes with positive results, but often leading to frustration over ineffective treatment and a sense of hopelessness. More alarmingly, these medications may aggravate the illness and have harmful effects on bipolar disorder treatment. While antidepressants’ potential for causing manic and hypomanic episodes has long been acknowledged, research now suggests that antidepressant use can trigger general instability and cause more frequent mood switching in people with rapid cycling bipolar disorder, resulting in not only mania and hypomania, but increasing the number of depressive episodes a person experiences. A 2013 study published in the Journal of Affective Disorders found that people with rapid cycling bipolar disorder saw a 286% increase in total mood episodes, a 293% increase in depressive episodes, and 28.8% less remission time when treated with antidepressants in combination with mood stabilizers, compared to those without rapid cycling. These differences were not observed in those treated with mood stabilizers alone. The results indicate that the specific presentation of your bipolar disorder must be considered to determine whether or not antidepressant use is appropriate for your situation.

In order to effectively manage your psychological distress, it is imperative that you first have a clear diagnosis. Bipolar depression is often confused with unipolar depression, as you may not recognize or remember manic or hypomanic symptoms. Without consistent mood tracking, you may not have a clear picture of your emotional patterns, leaving your psychiatrist without the information needed to accurately characterize your symptoms, leading to improper, ineffective, and even dangerous antidepressant treatment. Thorough psychiatric assessments, such as the evaluation process undertaken by clinicians at Bridges to Recovery, can help uncover the mood cycles that characterize bipolar disorder. By consulting with your family members and outpatient clinical team, we can gain a more complete understanding of your symptoms and identify the true nature of your illness without having to rely solely on your own perception and recollection. Once your diagnosis has been confirmed, our highly trained psychiatrists will develop a medication regimen designed to address your specific needs using the most up-to-date research to determine whether or not antidepressants are appropriate for you. Residential treatment affords the opportunity for close, continuous monitoring to guard against undesirable side effects and swift intervention to optimize therapeutic benefit. By working with experienced clinicians who understand the special needs of people experiencing bipolar depression, you can begin to heal from your illness and safely move towards lasting recovery.

Bridges to Recovery offers comprehensive treatment for bipolar disorder and combines the most effective therapies available to regain emotional stability and lay the foundation for long-term wellness. Contact us to learn more about how we can help you or your loved one start on the road to recovery.