Hypomania with antidepressants
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Hypomania with antidepressants -- is bipolar? (Joshua)

I have read that bipolars who take antidepressants can be kicked into (hypo)mania within the first two weeks of medicating, does this happen ONLY to bipolars?

Dear Joshua --

That's a great question.  Too bad we don't have some way of really testing this.  As you can see, it's almost more a question of how one defines bipolar disorder.  Shall we call anyone who has such a reaction "bipolar"?  There is a "bipolar III" that is defined this way, but that doesn't help much, as no one has reported data (to my knowledge) on what happens to BPIII people over time: if they never take another antidepressant, will they never have a "hypomanic phase" again?

However, here's a different way of looking at it I like better.  As I've tried to explain on my website about bipolar II, these questions should be thought of as a matter of degree, not yes or no.  My guess would be that someone who shows a little hypomania when given an antidepressant, has some low degree of risk and probably would show some subtle "hypomania" signs even off the medication: perhaps not enough to warrant treatment with a mood stabilizer, but perhaps enough to warrant avoiding antidepressants except exercise or lithium.  Yes, as I think about it, I like this system:
 
very mild hypomania on antidepressant use caution with antidepressants: 
Paxil, Wellbutrin, perhaps Effexor; avoid Zoloft, Prozac (Serzone has yet to declare its rank)
moderate hypomania on AD use antidepressant with mood stabilizer
severe hypomania on AD use antidepressants only with caution and solid mood stabilizer

And finally in the more-than-you-wanted-to-know process: many people with a clear bipolar diagnosis report that the first few antidepressants they took, e.g. including Prozac, worked "really well" -- and that sometimes it took years for them to start to show obvious increases in hypomanic symptoms due to antidepressants.

Dr. Phelps


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