My consultant tells me that SSRIs are the drug of choice for Bipolars.

[username]

Yup. He said that SSRIs are recommended for people with bipolar disorder, as opposed to medicines like duloxetine, venlafaxine or even reboxetine.

I thought that noradrenaline/norepinephrine tweaking was safer for bipolars.

Is he correct?

[Loon-A-TiK]

I dunno. I've read that Paxil and WB are the best to prevent bipolar complications. But heck, I'm just another "consumer".

[Guest FrannyNZooey]

Wow hope you are not prone to bouts of mania, and I mean severe going for weeks, months mania.

Zoloft, Wellabutrin, etc. were Hell for that, for me.

After stopping within week!

[Waterfall]

That's crazy. The two times in my life that I had full blown mania/mixed episodes was when I was on either Prozac or Lexapro. Not everyone is the same, but I think this doc needs to read the textbooks!

[Glen]

OBJECTIVE: Antidepressant responses were compared in DSM-IV bipolar and unipolar depression. METHOD: The authors analyzed clinical records for outcomes of antidepressant trials for 41 patients with bipolar depression and 37 with unipolar depression, similar in age and sex distribution. RESULTS: Short-term nonresponse was more frequent in bipolar (51.3%) than unipolar (31.6%) depression. Manic switching occurred only in bipolar depression but happened less in patients taking mood stabilizers (31.6% versus 84.2%). Cycle acceleration occurred only in bipolar depression (25.6%), with new rapid cycling in 32.1%. Late response loss (tolerance) was 3.4 times as frequent, and withdrawal relapse into depression was 4.7 times less frequent, in bipolar as in unipolar depression. Mood stabilizers did not prevent cycle acceleration, rapid cycling, or response loss. Modern antidepressants, in general, did not have lower rates of negative outcomes than tricyclic antidepressants. CONCLUSIONS: The findings suggest an unfavorable cost/benefit ratio for antidepressant treatment of bipolar depression.

http://ajp.psychiatryonline.org/cgi/content/full/161/1/163

[AirMarshall]

I did some checking and did NOT find anything suggesting that SSRI's are preferred over MRI's for bipolar. Nonetheless, SSRI's are mentioned most often as use as AD's.

In the US more so than UK, the consensus is that AD's are not preferred as primary treatment for bipolars, and that if they are used, that they should be an add-on to a strong mood stabilizer.

a.m.

[ncc1701]

Heya username,

Yah this all dovetails with what I've learned.

Stabilize first. Be very, very non-manic.

Then cautious addition of an antidepressant, if therapy isn't doing it.

The evidence is wishy-washy as to which AD. Which is I think why recommendations/practices vary.

All about caution.

--ncc--

[Anelize]

The best summary of the antidepressant controversy and the whole "switching" thing that I've read is on Jim Phelp's site:

www.psycheducation.org

You might want to check it out. Personally, I switched into severe mania on Lexapro, and wouldn't let anyone prescribe any SSRI to me again. I was on the fence about the Wellbutrin I'm just starting this week, but I'm having more frequent cycles into depression, and frankly, I was ready to try just about anything.

Good Luck.

[betcsu]

lexapro sent me very manic that took weeks to come down from.

ive been on lithium for a couple of weeks and today they added wellbutrin BUT pdoc made it very clear that he wanted to get me stabalized with the lithium before he added anything else. i go back in 2 weeks but he told me to call him at the first sign of ANYTHING with the wellbutrin and not to wait 2 weeks to report any problems.