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A recent large-scale study found that severe depression in patients with bipolar disorder responds no better to a combination of antidepressant medications and mood stabilizers than it does to mood stabilizers alone and that antidepressant use does not hasten the emergence of manic symptoms in patients with bipolar disorder. [40]
Antidepressants by themselves shouldn’t be used to treat bipolar disorder because they elevate the risk of triggering a manic episode. (Learn more about Antidepressants .)
It is known that even subclinical hypothyroidism can blunt a patient's response to both mood stabilizers and antidepressants. Furthermore, preliminary research into the use of thyroid augmentation in patients with refractory and rapid-cycling bipolar disorder has been positive, showing a slowing in cycle frequency and reduction in symptoms.
Another possible problem with antidepressants is the chance of antidepressant-induced mania or hypomania in people with or without a diagnosis of bipolar disorder. Many cases of bipolar depression are very similar to those of unipolar depression.
In general, large-scale studies do tend to show that long-term use of antidepressants is associated with weight gain side effects. However, study data on escitalopram and weight changes is very ...
There may also be a risk of accelerating cycling between phases when antidepressants are used in bipolar disorder. The risk of affective switches is higher in bipolar I depression; antidepressants are generally avoided in bipolar I disorder or only used with mood stabilizers when they are deemed necessary. [158] [24]: 63
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