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The use of antidepressants alone to treat bipolar disorders is rarely a good idea, although there are some patients who do well.

SSRI Antidepressants


The following excerpt is taken from Chapter 4 of Bipolar Disorders: A Guide to Helping Children and Adolescents by Mitzi Walsh, copyright 2000 by O'Reilly & Associates, Inc. For book orders/information, call (800) 998-9938. Permission is granted to print and distribute this excerpt for noncommercial use as long as the above source is included. The information in this article is meant to educate and should not be used as an alternative for professional medical care.

The use of antidepressants alone to treat bipolar disorders is rarely a good idea, although there are some patients who do well. Most experienced clinicians will use antidepressants only in addition to a mood stabilizer. That's because SSRIs (and other types of antidepressants) can trigger a rapid swing into mania.

Kara got worse when she was put on just an antidepressant. She got very manic, agitated, and aggressive. For depression we tried Effexor, which caused stomach problems; Serzone, which caused a bad reaction--she got very psychotic and out of control; Wellbutrin, which did nothing for her; nortryptyline, which worked for awhile. On Prozac she couldn't sleep, and Luvox didn't work. Zoloft is working well for her, with Neurontin. --Cindy, mother of 19-year-old Kara (diagnosed bipolar disorder)

•  •  •  •  •  

I have tried Prozac, and it was not good!!! Originally I was misdiagnosed as having depression. I was placed on Prozac, which caused a manic/hypomanic cycle. I was immediately taken off Prozac and rediagnosed as BP2. I was then placed on lithium, and I have been stable ever since.

In addition to the lithium, I also take a small dose of Zoloft. This was done mainly because of the severity of my depressions. --Marcia, age 24 (diagnosed bipolar II disorder)

Today's antidepressants are much more advanced than those used just a decade ago, but they're still a blunt instrument for attacking brain dysfunction. There are several different types, and within each group related medications may function quite differently. That's why you shouldn't write off a whole family of drugs just because one was a disaster. A slightly different medication may turn out to be infinitely preferable.

All of the antidepressants should be used with care. Check package inserts and pharmacy information sheets to avoid interactions with other medications. Be sure to tell your doctor about any over-the-counter drugs you use, even aspirin, herbal medicines, or supplements.

The brain is chock-full of serotonin receptors, tiny sites that bind with serotonin molecules to move chemical impulses through the brain. The selective serotonin reuptake inhibitors (SSRIs) block certain receptors from absorbing serotonin. Researchers believe this results in lowered or raised levels of serotonin in specific areas of the brain. Over time, SSRIs may cause changes in brain chemistry, hopefully in a positive direction. SSRIs may also cause actual changes in brain structure with prolonged use. There are also receptor sites elsewhere in the central and peripheral nervous systems, so SSRIs can have an impact on saliva production, appetite, digestion, skin sensitivity, and many other functions.

The SSRIs are not identical in either their chemical composition or their effects on the brain. Prozac and Zoloft tend to have an energizing and focusing effect as well as reducing depression, for example, while Paxil may calm anxious or agitated patients who are also depressed.

The following five drugs are currently considered part of the SSRI family.

Celexa

Generic name: citalopram

Use: Depression

Action, if known: SSRI--increases the amount of active serotonin in the brain. Has a calming effect.

Side effects: Dry mouth, insomnia or restless sleep, increased sweating, nausea, sexual dysfunction. Lowers the seizure threshold. Can cause mood swing in people with bipolar disorders.

Known interaction hazards: Alcohol. Never take with an MAOI, or soon after stopping an MAOI. Use with caution if you take a drug that affects the liver, such as ketoconazole or the macrolides.

Tips: People with liver or kidney disease should be monitored regularly while taking Celexa.

Luvox

Generic name: fluvoxamine

Use: Depression, OCD.

Action, if known: SSRI--increases the amount of active serotonin in the brain.

Side effects: Headache, insomnia, sleepiness, nervousness, nausea, dry mouth, diarrhea or constipation, sexual dysfunction. Lowers the seizure threshold. Can cause mood swing in people with bipolar disorders.

Known interaction hazards: Never take with an MAOI, or soon after stopping an MAOI. Potentiated by tricyclic antidepressants and lithium. Potentiates many medications, including clozapine, diltiazem, methadone, some beta blockers and antihistamines, Haldol and other neuroleptics.

Tips: Avoid taking this drug if you have liver disease. Cigarette smoking may make Luvox less effective. Luvox does not bind to protein in the body, unlike the other SSRIs, and may have a very different effect in some people.

Paxil, Seroxat

Generic name: paroxetine

Use: Depression

Action, if known: SSRI--increases the amount of active serotonin in the brain. Has a calming effect.

Side effects: Headache, insomnia or restless sleep, dizziness, tremor, nausea, weakness, dizziness, sexual dysfunction, dry mouth. Lowers the seizure threshold. Can cause mood swing in people with bipolar disorders.

Known interaction hazards: Alcohol. Never take with an MAOI, or soon after stopping an MAOI. Potentiates warfarin, theophylline, paroxetine, procyclidine. Changes how digoxin and phenytoin act in the body.

Tips: People with liver or kidney disease should be monitored regularly while taking Paxil.

Prozac

Generic name: fluoxetine

Use: Depression, OCD, eating disorders, ADHD, narcolepsy, migraine/chronic headache, Tourette syndrome, social phobia.

Action, if known: SSRI--increases the amount of active serotonin in the brain. Usually has an energizing effect.

Side effects: Headache, insomnia or restless sleep, dizziness, tremor, nausea, weakness, dizziness, sexual dysfunction, dry mouth, itchy skin and/or rash. May cause change in appetite and weight. Lowers the seizure threshold. Can cause mood swing in people with bipolar disorders.

Known interaction hazards: Alcohol. Never take with an MAOI, or soon after stopping an MAOI. Do not take over-the-counter or prescription cold or allergy remedies containing cyproheptadine or dextromethorphan. Potentiated by tricyclic antidepressants. Potentiates lithium, phenytoin, neuroleptic drugs, carbamazepine, and cyclosporine. Reduces effectiveness of BuSpar.

Tips: Prozac has a long life in your body. People with liver or kidney disease should be monitored while taking Prozac.

Zoloft

Generic name: sertraline

Use: Depression, OCD, obsessive-compulsive behavior.

Action, if known: SSRI--increases the amount of active serotonin in the brain. Has an energizing quality.

Side effects: Dry mouth, headache, tremor, diarrhea, nausea, sexual dysfunction. May precipitate a manic episode in people with bipolar disorders. Lowers the seizure threshold.

Known interaction hazards: Alcohol and all other central nervous system depressants. Never take with an MAOI, or soon after stopping an MAOI. Potentiates benzodiazepine drugs and warfarin. Potentiated by cimetidine.

Tips: People with epilepsy, bipolar disorders, liver disease, or kidney disease should be carefully monitored if they take Zoloft. May affect therapeutic level of lithium.


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