Bipolar Disorder – When to Get Off Antidepressants

I try not to give medical advice here because I am not a doctor. But so many people ask me about this I felt I had to address getting off antidepressants without withdrawal. So many people with bipolar disorder (depression and others) need information about getting off psych meds and they are not getting it from their doctors.

This is the first in a three-part series:

  1. When to Stop Antidepressants in Bipolar Disorder
  2. How to Stop Antidepressants in Bipolar Disorder While Minimizing Withdrawal
  3. How to Stop Taking venlafaxine (Effexor) and Desvenlafaxine (Pristiq) – as they are particularly nasty to get off

This is an informational article only and should not be considered a recommendation. Talk to your doctor before any and all changes to your treatment. I’m not kidding about this.

These recommendations are primarily from PsychEducation.org and Dr. Jim Phelps with some commentary by me.

Bipolars Shouldn’t Take Antidepressants

Some doctors are on the fence about this, but more and more bipolar specialists are recommending people with bipolar disorder not take antidepressants. There are lots of reasons for this, and I have to tell you, they are compelling.

Why Shouldn’t People with Bipolar Disorder Take Antidepressants?

Some reasons people with bipolar shouldn’t take antidepressants:

  • Antidepressants may not work in bipolar disorder – believe it or not, the literature is mixed on how well antidepressants even work for bipolar depression.
  • Antidepressants can induce mania or hypomania (known as switching) – most of us have seen this and it happens all the time to bipolars who are prescribe antidepressants by non-psychiatrists because they just don’t understand the danger. And it is very dangerous because once switched, this type of mania or hypomania can be treatment resistant.
  • Antidepressants can induce rapid-cycling or mixed moods – same as above, this cycling can be treatment-resistant.
  • Antidepressants can worsen a bipolar’s illness overall – this is more controversial and I suspect varies case by case.

Bipolar Disorder and No AntidepressantsTo be clear some people with bipolar disorder will always need antidepressants temporarily, or long term, for their mood, but more and more, doctors are saying to avoid them whenever possible. (Alternatives will be presented in a future article.)

When to Stop Taking Antidepressants

Here are some guidelines from Dr. Phelps about when to stop taking antidepressants in bipolar disorder:

  1. If they have been on antidepressants a short time, I stop them.
  2. Less than a week, stop; two weeks, cut in ½, a week later stop.
  3. Likewise, if they just increased their antidepressants dose I will do the above, decreasing to their previous dose and get rid of the rest later.
  4. If manic or severely hypomanic, get rid of antidepressants now.  Usually can stop abruptly.
  5. If cycling or mixed get rid of the antidepressants.
  6. If they are not getting better after several add-on meds then slowly decrease.
  7. There are more exceptions to the above rules than there are rules.

When to Stay On an Antidepressant if You’re Bipolar

More guidelines from Dr. Phelps: When a bipolar should stay on an antidepressant:

  • If the patient is doing well, no mixed state symptoms or cycling, leave it.
  • I usually wait until the patient is doing better to much betterto stop an antidepressant; why:
  • Trust is an issue.  If the first thing we do is make them suffer more they will be unlikely to stay around long and may not even go to another psychiatrist.
  • Even though we know the antidepressant is causing harm often time the patient thinks either the antidepressant is helping or every time they try to go off they feel much worse.
  • Waiting until they are better is usually a good thing.
  • Also waiting longer usually means that the patient is going to be more educated about bipolar in general.

When to Get Off an Antidepressant Recommendations

I think Dr. Phelps’ recommendations are good ones, otherwise I wouldn’t have them here, but note where he says there are more exceptions than he has listed, so keep in mind, you might fall into one of the unlisted exceptions.

And I think the part above where Dr. Phelps talks about trust and making sure the patient is better before messing around with their cocktail is key. It shows he’s respecting the patient and their health, not to mention the doctor-patient relationship which is very important.

Talking to Your Doctor about Getting off Antidepressants is Scary

I know it’s scary to think about going off antidepressants, even if you do think they are causing problems. But think about it, discuss it with your doctor and make the right decision for you. And don’t do anything until you read the next part about how to get off antidepressants without withdrawal.

Bipolar Disorder – Getting off Antidepressant Series

  • Bipolar Disorder – When Not to Take Antidepressants

Coming up:

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