In bipolar disorder, why should antidepressants not be used as monotherapy during mania?

• A. They can precipitate or worsen mania or hypomania; mood stabilizers or antipsychotics are preferred
• B. They have no effect in mania
• C. They cause weight gain
• D. They interact with vitamins

Answer: (A)

Antidepressants should not be used alone during mania because they can push a patient from a manic state into more pronounced mania or trigger a switch to mania (or hypomania). In bipolar disorder, mood regulation is fragile, and boosting monoamine activity with antidepressants can destabilize the already elevated mood. To prevent this, clinicians use mood stabilizers or antipsychotics to directly control mania and provide true mood stabilization. Antidepressants aren’t effective by themselves for treating mania and, in fact, carry a real risk of worsening it. If antidepressants are considered at all, they are paired with a mood stabilizer to reduce the risk of switching, and they’re generally reserved for bipolar depression rather than acute mania.