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October 5th, 2010
08:35 AM ET

Can antidepressants raise liver enzymes?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Ann, of Bloomfield, New York

How do I help my daughter who has a diagnosis of bipolar and each time the doctors put her on an antidepressant, her liver counts go up and she goes into mania? This happens when the liver levels rise. It takes at least two weeks to cycle through.

Expert answer

Dear Ann,

The short answer to your question on how to help your daughter is to get her under the care of a clinician who will stop prescribing her antidepressants. We've known for years that antidepressants can worsen the course of bipolar disorder, at least in some patients. While some bipolar people take antidepressants without difficulty - and in fact need them - others have symptoms much like your daughter's every time they are placed on them.

Many psychiatric medications can increase "liver counts," by which you mean blood measures of liver enzymes. Usually this is not something to worry about. I've known some world-famous gastroenterologists who counsel psychiatrists not to worry about these short term rises in liver counts - even when the counts double. Every once in a while a medication will really damage the liver and counts will really shoot up. That is a different and very serious issue.

Although antidepressants can make bipolar patients manic and they can raise liver counts, these two effects are probably not connected. We are not sure how antidepressants induce mania. Recent studies suggest that people with certain genes are more likely than others to have this problem, and it is not just medications that can do this. Sleep deprivation is especially famous for its ability to make people manic.

I do not know your daughter's treatment history from this short question. Let me assume she has  been treated only with antidepressants. If so, the good news is that multiple other medications are likely to be of far more help to her both in terms of her depressions and manias. The classic medication in this regard is lithium. Newer medications that have been shown to stabilize mood in bipolar disorder include valproic acid (Depakote), carbamazepine and oxcarbazepine, lamotrigine (Lamictal) and several of a class of medications known as atypical antipsychotics.

I have seen countless people treated with the wrong medications who made remarkable recoveries when started on medications better suited to their diagnosis. Given your question, it is likely your daughter may be one of them.


soundoff (5 Responses)
  1. Elle

    as an adult first diagnosed with chronic severe depression, let me start out by saying that while I don't have bipolar, many antidepressants gave me seemingly miracle results. by this i mean instant energy & lots of it. my liver enzymes were never checked, and when the depression worsened, the dosages always increased. most of my adult life centered around the meds-and me wondering why this cycle continued. it wasnt until i became homeless (depression) that a clinician took one look at my pharmocology history and gave me a little medical pamphlet grouping antidepressants into bipolar safe or unsafe. every antidepressant i'd taken for over 21 years but one was listed-the one i was taking at the time. and guess what? thats the one i'd told her was working-like a miracle, it seemed. if only one clinician had stopped and put my pharmocological history with my family history. while i don't have bipolar, my father did-as does a brother. one round on the correct class of antidepressants fixed my brain and i haven't had a serious setback for many years. great article and great question too!

    October 6, 2010 at 03:00 | Report abuse | Reply
  2. Elle

    As an adult first diagnosed age 17 with depression this intrigued me. for 21 years they threw every antidepressant known to increase energy at me. all gave me what i'd term false mania. drs liked the reaction but not me. i was cranky and felt mean. all reassured me this was normal and when the depression got worse-3 weeks like clockwork-they'd increase the dosage. then the cycle would just start over! seemed to me the only way to feel sane was to go off meds at which dr and family would infer i "wanted the depression". long story short, the last med worked but by then i'd lost my house car job been abused, and was homeless. when i told the clincian at the clinic for homeless people my history, she was shocked. turns out that while i am not bipolar, my father and brother do, and every single last med excluding one was known to bring on manic episodes in people predisposed to bipolar. i'll close this out by saying that after a few months on the right kind of antipressant, 21 years of depression went away by like 95 percent, and what lingers is treatable with supportive therapy when it occurs, which is hardly ever.

    October 6, 2010 at 03:24 | Report abuse | Reply
  3. Elle

    Whoops didnt mean to double dip there! moderator can u remove the 1st port please? thankx!

    October 6, 2010 at 03:27 | Report abuse | Reply
  4. sbulcroft

    First, Depakote isn't a "new med" and was first used for depression before it became an anti seizure med. Secondly, the atypical anti-psychotics have their own problems when it comes to the liver and kidneys so I would be careful using something like this off label. Just because a few MD's say don't worry about it's effect on the liver doesn't mean that this is wise. And where is the information on using cognitive behavioral therapy for bipolar/depression. Changing the way one thinks and perceives as well as other behavioral changes can be even more helpful then medications – it just takes longer but last longer too!

    October 6, 2010 at 09:59 | Report abuse | Reply
  5. Jim Phelps, M.D.

    Dr. Raison's comments are an excellent summary of the relevant information. He has cautiously explained a very controversial subject in psychiatry, the role of antidepressants (is there any?) in the treatment of bipolar disorder. Very reassuring to find someone of his experience thinking just like I do! Thanks, Dr. Raison.
    Jim Phelps

    November 11, 2010 at 19:41 | Report abuse | Reply

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