Tracyrip - All antidepressants can (and seemingly have) caused "manic switch" in those with bipolar disorder. The extent with which the newer agents, like Effexor™ (venlafaxine) or the SSRIs (incl. Luvox™ - fluvoxamine) cause manic switch seems to be less than is seen with the older agents (eg. TCAs and MAOIs).

I have heard many theories for why antidepressants seem to cause manic switch. One is that the antidepressants decrease the depressive side of the bipolar illness and the sensitive neurotransmitter systems of the person with bipolar disorder overshoots normal mood and results in hypomania. Another is that depression in bipolar disorder is holding the mania in check, and when the depression is relived the mania comes back. I don't think that either of these theories have been proven.

Not everyone who has bipolar disorder who takes an antidepressant will become manic or hypomanic. Many people with bipolar disorder have taken antidepressants for years, without any manic or hypomanic episodes. Current theories suggest that about 50% of people with bipolar disorder taking the older TCAs (tricyclic antidepressants like imipramine), 33% of those taking SSRIs, and 13% of those taking Wellbutrin™ (bupropion) will have a manic switch. This includes people who are already taking a mood stabilizer.

Many of those who have bipolar disorder (especially the Type II variant) need to take some sort of antidepressant to fight the debilitating, sometimes life-threatening, depression. Some of the newer mood stabilizers seem to have built-in antidepressant activity. This is especially true for Lamictal™ (lamotrigine) and possibly Topamax™ (topiramate). These two medications do not seem to cause manic switch, but since they are new and we are not sure what causes manic switch, I will not say that they won't with any absolute certainty that manic switch will not happen.

Many people who have had a manic episode and are successfully treated with mood stabilizers will end up missing some parts of the manic feeling. Unfortunately, we cannot give a person a little mania without the risk of the unsafe behaviors that can result from it.

I hope that this is of some help. - Cam

<font color=orange>"Sometimes you may be shown the light in the strangest of places, if you look at it right"
- Robert Hunter</font color=orange>