Why do SSRIs worsen bipolar disorder in a 23-year-old?

Question

Hello doctor,

I hope you’re doing well.

I am writing to seek your advice on my 23-year-old cousin, who has been diagnosed with bipolar disorder. He was recently prescribed Fluoxetine for depression, but since taking the medication, he has grown more anxious and has had difficulty sleeping. Our family is concerned about the events.

Can you explain why someone with bipolar disorder might feel worse when taking SSRIs like Fluoxetine?
Is it possible for antidepressants to cause mania or make mood swings worse in these cases?

We would also appreciate your advice on the best way to treat bipolar depression, especially how to manage symptoms while reducing the risk of these side effects.

We would greatly appreciate your guidance on how to better manage this condition.

Thank you for your time and support.

Answer 1

Hello,

Welcome to icliniq.com

I read your query and understand your concern.

Fluoxetine can sometimes cause people to feel more anxious, restless, or have trouble sleeping, especially in the first week of treatment. These side effects are likely due to changes in serotonin levels and usually get better within one or two weeks. For this reason, it is usually best to take Fluoxetine in the morning.

For people with bipolar disorder, doctors are careful when prescribing antidepressants like Fluoxetine because these medicines can sometimes cause manic episodes or make moods less stable. Most clinical guidelines do not recommend using antidepressants for bipolar disorder as a standard treatment. However, they may be used carefully if depressive symptoms continue.

Many studies suggest that antidepressants might raise the risk of mania or make bipolar disorder harder to manage. However, large studies like the Systematic Treatment Enhancement Program for bipolar disorder (STEP-BD) trial did not find a big difference between some treatment groups.

Treating bipolar disorder is tailored to each person and depends on things like how severe the symptoms are, the course of the illness, age, gender, how often episodes happen, and how well the person tolerates medications. Most guidelines suggest starting with a mood stabilizer and adding other medicines if needed.

I hope this addresses your concerns.

Please feel free to follow up if you need any additional clarification.

Thank you.