SSRIs and the Treatment of Bipolar Disorder
Serotonin is a brain chemical that helps regulate mood, anxiety, sleep/wake cycles, sexual behaviors, and many other brain and body functions. Selective Serotonin Reuptake Inhibitors (SSRIs) increase the level of serotonin in the synapses — the spaces between brain cells (neurons) — in the brain.
However, the mechanisms of action of SSRIs are more complex than simply increasing serotonin levels. Understanding of the circuits in the brain that regulate mood is still limited, but ongoing research will reveal more over time.
The following table lists the most common SSRIs along with their potential pros and cons. The table also includes olanzapine fluoxetine combination (Symbyax), which is a combination medication that includes the atypical antipsychotic olanzapine and the antidepressant fluoxetine. This medicine was specifically formulated to treat bipolar depression.
SSRIs may take several weeks to become fully effective, so keep taking the medication even if you don’t experience immediate relief.
|Generic Name||Brand Name||Average Adult Dose||Potential Benefits||Some Possible Side Effects*|
|Citalopram||Celexa||20 to 40 mg/day||Antidepressant (approved for treatment of unipolar depression).
Not approved but often prescribed for use in bipolar depression.
Also used to treat many anxiety disorders but can present
challenges in someone with bipolar disorder.
|Suicidal ideation; insomnia; sedation; agitation; mania; change
in sexual function; nausea or diarrhea; weight gain; night
|Escitalopram||Lexapro||10 to 20 mg/day; sometimes more|
|Fluoxetine||Prozac||20 to 60 mg/day|
|50 to 300 mg/day|
|10 to 60 mg/day; sometimes more|
|Sertraline||Zoloft||50 to 200 mg/day|
|Olanzapine + fluoxetine||Symbyax (Zyprexa + Prozac)||3/25 to 18/75 (Tablets are labeled with the olanzapine dose on
top and the fluoxetine dose on the bottom, so a Symbyax 3/25 tablet
contains 3 mg of olanzapine and 25 mg of fluoxetine.)
|Treats bipolar depression.||Weight gain; increased blood sugar and cholesterol levels;
akathisia; sedation or insomnia; reversible movement disorders;
suicidal ideation; nausea/diarrhea.
mg/day = milligrams per day.
* Other side effects may occur that aren‘t listed.