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Bipolar Depression Treatment

Treatment of Bipolar Depression and detailed explanation of medications for Bipolar Depression.

Treatment of Bipolar Depression and detailed explanation of medications for Bipolar Depression.

Antidepressant medication treatment for depression is often more successful than medication treatment for bipolar depression- simply because researchers know more about the depressed brain than the bipolar brain. Medications are developed from brain research- not the other way around. Antidepressants that are clearly established as effective treatments for depression, generally do not successfully treat bipolar depression, and in many instances can make it worse. The biggest concern is that antidepressants can cause mania. A further complication of antidepressant use in bipolar depression is the chance of rapid cycling where, over a period of time, episodes of mania and depression become more frequent. As researchers better understand the bipolar brain, they can come closer to creating antidepressants that don't cause mania. That will be a great day for all people with bipolar depression!

Depression and Bipolar Depression Medication Categories

There are four main medication categories used to treat depression and bipolar depression. The medications are sometimes used interchangeably for each depression, but bipolar depression almost always requires more medications in order to keep all of the symptoms under control without igniting mania. Treatment is complicated, but it's not difficult to learn the medication categories used to treat mood disorders.

Mood Stabilizers: There are four mood stabilizers used to treat Bipolar disorder:

  1. Lithium
  2. Tegretol
  3. Depakote
  4. Lamictal

In reality, only Lithium is a true mood stabilizer. The other three are anticonvulsants that were created for epilepsy and just happened to work on mood disorders. Lithium, Depakote and Tegretol often work miracles with mania, but only Lamictal is used to manage depression.

Antipsychotics: These are medications used to manage the psychosis that can come with depression, mania and mixed episodes. These are more commonly used for Bipolar Depression treatment than Depression. You may remember the old antipsychotics such as Thorazine or Haldol. There is now a new category called atypical antipsychotics that have less side-effects- though many people will tell you they can still have plenty! These include:

One of these drugs, Seroquel, has recently been found to be very effective in treating BIPOLAR depression, even when there are no psychotic symptoms.

Antidepressants: The most familiar antidepressants are the SSRI's such as Prozac, and Celexa. There is a second category called SNRI's, such as Effexor, that also work very well to manage Depression. As said before, the problem is that ALL of these drugs can ignite mania. There are no exceptions. This doesn't mean that people with Bipolar Depression can't take antidepressants. Many do, but to be safe, they should always be used with a mood stabilizer or antipsychotic that prevents mania. As you can imagine, this can get very complicated and it's essential you have vigilant medical management any time a new drug is tried.

Benzodiazapines (Antianxiety Medications): These are used to manage the anxiety that is very common with both types of depression. They are also used as a sleep aid. These include:

Yes, there is a risk of addiction with these drugs, but many use these drugs for anxiety and sleep with no addiction problems.

Medication Cocktails

Most people with Bipolar Depression who are successfully treated often take several drugs simultaneously. Results from a recent Bipolar Disorder research project called the STEP-BD Project found that 89% of those successfully treated for Bipolar Disorder required, on average, three medications from the above categories. According to the recent STAR-D research project, people with Depression who don't respond fully to one antidepressant often respond successfully to two or more medications. My Gold Standard Treatment articles for Depression and Bipolar Disorder mentioned at the beginning of this article give more in-depth information on the successful medication treatment of mood disorders.


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Last Updated: 11 July 2017
Reviewed by Harry Croft, MD

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