Treatment of Bipolar Disorder

Critical Safety Concerns

• The American Academy of Child and Adolescent Psychiatry explicitly warns that antidepressant monotherapy can trigger manic episodes or rapid cycling in bipolar disorder 1, 2
• Treatment with SSRIs should be avoided in men with a history of bipolar depression due to risk of mania 3

Recommended Treatment Algorithm for Bipolar Depression

• The American Academy of Child and Adolescent Psychiatry recommends olanzapine-fluoxetine combination or a mood stabilizer with careful addition of an antidepressant for bipolar depression 1
• Start with lithium, valproate, lamotrigine, or an atypical antipsychotic as monotherapy 1

Common Pitfalls to Avoid

• Never use Trintellix or any antidepressant as monotherapy in bipolar disorder—this is the single most important contraindication 1
• Do not continue antidepressants indefinitely without reassessing need, as they may destabilize mood over time 1