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February 22nd, 2011
09:07 AM ET

Can antidepressants jump-start bipolar disorder?

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.

Asked by Michelle, Michigan

I had an untreated health issue for a couple of years that threw me into a mild depression. I have a mother and brother who are bipolar and one of the things my therapist told me is that studies show that if you go on an antidepressant and there is a history of bipolar in your family that this can sometimes "kick in" the bipolar. I am lucky and was able to get past my depression with therapy, exercise, etc. I was just wondering what your thoughts were.Expert answer

Dear Michelle,

I've got a lot of thoughts about your question, and they are all confused! In this way I am much like the field of psychiatry as a whole. Ten years ago I would have told you that what you'd heard was absolutely correct and that people with bipolar disorder should avoid antidepressants because of the risk these medications pose in terms of making vulnerable people manic.

I still mostly believe this, but a number of large studies done over the last five years do not do much to confirm the idea that antidepressants are dangerous for people with - or at risk for - bipolar disorder. In these studies, people with bipolar disorder seem able to take antidepressants and not "go manic" at any higher rate than they would have naturally.

On the other hand, anyone who has practiced psychiatry for any time at all can tell you stories of people like yourself with a bipolar family history who went manic soon after going on an antidepressant for the first time. So what's the truth? We just don't know.

In fact, we don't even know whether antidepressants help people with bipolar disorder who get depressed. It's interesting. Studies done on the East Coast of the United States tend to find that antidepressants do not help, whereas studies done on the West Coast suggest that they are of tremendous benefit. What's the truth? We just don't know yet.

There are a few things I think we can say with at least a little certainty. First, we know that people from families with bipolar disorder are twice as likely to have "regular old" depression than to have classic bipolar disorder. Like everyone else, these folks should have their depression treated as rapidly and completely as possible, and antidepressants are often hugely useful in accomplishing this. On the other hand, there is at least some evidence that people with family histories like yours may be at an increased risk of having a manic episode on an antidepressant. This wouldn't stop me from using one, but I'd watch with extra caution. The good news is that you tapped into other well documented antidepressant strategies, including exercise and psychotherapy.


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  1. Neil

    It is safe to say that ssri antidepressants not only trigger psychotic symptoms including mania, they often create new and permanent psychotic illness in individuals taking them. This is occurring at rates well over 400% higher in users than in the typical population, and if that much evidence existed on the harmful effects of marijuana it would not be legal anywhere. SSRI's were only tested for a very short duration of time on patients, almost no information was gathered on the effects of these drugs on the human body becuase there exists no way to test for them. This creates what is known as plausible deniability since medicine doesn't know what ssri's do they can say they are not responsible for creating new and much more serious problems in patients, and there is no way to prove otherwise. Unless you look at the numbers, the numbers show the onset of new psychiatric illness in people taking antidepressants to be exponentially higher than in any control group, studies tend to disappear rapidly after being released. Find a free clinic do a study yourself, you'd be surprised how many people will willingly volunteer, and you'll also be surprised how quickly teams of lawyers from pharmaceutical companies shut down the reporting of your findings. Pharma is not going to conduct this type of study when they are not made to do so, and also know it will end their selling of a line of medication that has made them billions of dollars it's their golden goose.

    October 19, 2013 at 06:05 | Report abuse | Reply
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      Where did you read that the spychosis caused by ssri use is permanent? That is not true is temporary

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  2. Joanna

    This happened to me. Two members of my immediate family had been diagnosed with bipolar. There was also a family history of "hyper-religiosity". I suffered a situational depression due to overwork and interpersonal issues. Without taking a family history at all, my doctor proscribed Zoloft. Within two weeks I was out of my mind, in a psychotic mania. Now I have bipolar disorder and have to take Lithium for the rest of my life, or until my kidneys fail ... Otherwise I slip into cycling mixed manic episodes.
    SO, if you have any family history of bipolar, or other markers such as "nervous breakdowns" , drug abuse, "hyper-religiosity"etc, DO NOT take SSRIs for your depression. There may not be solid clinical evidence, but the lived experiences tell a different story.

    July 19, 2016 at 21:00 | Report abuse | Reply
  3. Lucille whitehead

    I am bipolar two my husband is bipolar one with scitzofrenic tendencies. I have hypomania so I take moodstablelizer and two kinds of antidepressant and my husband take a moodstablelizer and a antiphychotics. You always have to take a moodstablelizer with any kind of bipolar and yes if you have mania it can't be controlled without a moodstablelizer. The best person to treat this is a phychiatrist. It is a desease and without these pills your brain detereates that much faster. My husband had to be hospitalized for two weeks to get on these medications for his mania was so bad and he was so far gone he was unable to see how sick he was. He and I are doing fine now. We have been married for 43 years.

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    After years of having BiPolar affect me personally, I do not believe the disorder exists. I believe it happens in this order: For whatever reason, stress in one's life causes increasing depression. An antidepressant is prescribed. If you you react poorly to it you are immediately diagnosed with BiPolar. I believe this is sadly a reaction your brain has to the meds upsetting it. It is trying to let people know their system doesn't like it. Then, if you are diagnosed with bipolar, mood stablilizers enter the picture. They know now that any psychiatric drugs alter the neurons of the brain and if you are on them long enough, teach the brain not to produce its own serotonin so if people try to get off the meds and the symptoms return, they are convinced they still have bipolar, no, they have become addicted to the meds because they supply the chemical equivalent of serotonin that the brain no longer can.

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.