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anti depressants and bipolar disorder


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okay, so hopefully someone has the answer for me.................. ive heard and been reading how bipolars should not be given antideprressents... thoughts?????

This is not a universal truth. While it is true that antidepressants will often have the effect of mania in those with bipolar, this is not always true. For those in whom it is true, it can be avoided often, though not always, but starting a mood stabilizer first and establishing a treatment plan with that type of medication first, to avoid a mood swing into hypo/mania.

Not all bipolars will be sent into hypo/mania by antidepressants alone, and it is not a requirement for being dx'd, something which is a common misonception.

It is prudent, however, to use caution when administering ADs as there is really no way to TELL what will happen, just like with any other med. No guarantees.

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okay, so hopefully someone has the answer for me.................. ive heard and been reading how bipolars should not be given antideprressents... thoughts?????

There are three main "classes" of antidepressants defined by how they work, another by the general shape of the chemicals.

Of these classes of drugs,

"SSRIs" - selective serotonin reuptake inhibitors - work by keeping serotonin in your nerve synapses as long as possible. Somehow, this can end up sending SOME people with bipolar disorder into mania or hypomania if that's the only medication they are on.

"SNRIs" - selective noradrenaline reuptake inhibitors - work by keeping noradrenaline in your nerve synapses as long as possible. Noradrenaline is not serotonin. Period. These few antidepressants may have the best record for relieving bipolar depression without inducing (hypo)mania, but for SOME people that still does happen.

"MAOIs" - monoamine oxidase inhibitors - work by shutting down the enzyme that clears out used neurotransmitters. Because of how they do that, there are special restrictions on diet and medications. They have been used in treating bipolar depression, but they are NOT first-line meds even for depression these days.

"TCAs" - tricyclic antidepressants and tetracyclic antidepressants - are defined by how the molecule is drawn on paper. Some are strong enough antihistamines to make Benadryl feel like tap water in comparison, and might be used to cause sleep or even stop/prevent manic episodes. Others function almost just like Prozac. Still others are so activating they get prescribed for ADHD. Some get used for treating chronic pain.

And there are other antidepressants that may combine effects or structures...

Take-home message:

After all the mice are back in their cages, an "antidepressant" is just a drug that's primarily approved for use in relieving depression. That's all the term really means.

If a lay person giving you advice doesn't know or understand that not all ADs are or act like the SSRIs, he just doesn't know what he's talking about - probably repeating he heard from someone who read something somewhere.

If your doctor doesn't care about the difference, it probably isn't safe for him to prescribe an antidepressant to you anyway (some of these meds can be deadly in overdose or in the wrong combinations.)

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There are three main "classes" of antidepressants defined by how they work, another by the general shape of the chemicals.

And yes, I know I skipped over the multiple reuptake inhibitors, a banned dopamine reuptake inhibitor, a serotonin reuptake enhancer, a direct melatonin agonist, various off-label uses and last-ditch meds, and some of the exotic-but-promising ADs being worked on that target other brain chemicals...

... and just for HerrFous, cough syrup!

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