Expert: Ivan Goldberg, M.D. - 2/3/2005

Question
I am a 66-year-old woman with Bipolar II disorder.  My first episode, a severe depression, occurred at age 18.  I have not experienced a hypomanic episode in more than 20 years.

Over the years I tried many antidepressants, including the 2nd and 3rd generation meds, but the most successful...hands down...have been the tricyclics.  During the time that I used them, including one stetch of three or four years when my doctor felt I should take them indefinitely, I  never experienced a manic or hypomanic episode.  

Given the current awareness that antidepressants, especially the tricyclics, may not be the best course of treatment for bipolars,  I am distressed that the medication that worked wonders for me for years is no longer indicated.

Do you know what percentage of bipolars will experience antidepressant related problems and whether there are any predictors for identifying those patients who will?

Answer
Hi . . .

The best estimate is that between 20% and 25% of people with Bipolar disorder who take antidepressants will go on to develop mania/hypomania/rapid-cycling/mixed states.

The safest thing for someone with Bipolar Depression to do is either:

take antidepressants along with lithium or another mood stabilizer

or

take Lamictal, a mood stabilizing anticonvulsant with good antidepressant properties. See: http://www.psycom.net/depression.central.lamotrigine.html

Best regards . . .

Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%