Q:  Can SSRIs Cause More Severe Depression?

Dr. Phelps,

I have been diagnosed with bipolar disorder II with rapid cycling.   It is known that SSRIs like Prozac taken alone in people with bipolar disorder can trigger mania.

Is it also possible that it could cause a more severe case of depression in cases where the symptoms in the bipolar disorder are mainly depression?  Have you heard about it from your patients or can you confirm/deny this otherwise?

Thanks,


Dear S' -- 
Yes, I think I've seen this, quite commonly actually.  Antidepressants can induce cycling (there is no debate about that part).  And in my experience it seems that sometimes the cycling can become more dramatic, including not just more dramatic hypo/manic symptoms, but also more severe depressive symptoms.  

There is still pretty clear consensus amongst mood experts that if a person is having "rapid cycling" (technically this requires only that there be more than 4 episodes in a year, though usually what we see is mood shifting as often as every week, sometimes nearly every day, and more rarely shifting within a day, so-called "ultradian cycling"), the this is best addressed by tapering off the antidepressant (though many of us would add some additional mood stabilizer in the short run at least, depending on how bad the person's symptoms were prior to and during the transition).  There is no consensus on how rapid that taper should be, but there is clear recognition of the risk of worsening the illness, at least temporarily, by stopping quickly -- so-called "antidepressant-discontinuation induced mania" -- so you should discuss carefully with your doctor any plan to stop your antidepressant, if you're taking one.  

Dr. Phelps