Unlike unipolar depression (not bipolar form), antidepressants are of little value, especially when used for prevention of future episodes. There may be a limited role for antidepressants in Bipolar II Disorder but rarely any for Bipolar I. Bipolar II means that the person only has recurrent depression and never full blown mania, just hypomania (less severe and does not compromise functioning).
Not only are antidepressants of little or no value in Bipolar I depression, they can also be harmful. The main risk is increasing the rapidity of cycling and may cause dysphoria. Some authorities also believe they can trigger manic episodes. This is consistent with my clinical experience.
So, if antidepressants are not helpful, what can be done? Exercise, especially aerobic exercise like walking clearly helps, although it is hard to be motivated to exercise if you are depressed. However, getting out and walking for just 15 minutes can make a difference. Cognitive-behavior therapy has been shown to benefit many patients. Usually, 12 to 16 sessions with a trained therapist are needed.
Omega-3 fatty acids can often help and will also lower triglycerides and raise good cholesterol (HDL). You need at least 1 gram of EPA per day. Some forms of brief light therapy helps some patients.
If a patient's thyroid tests show high normal levels of the Thyroid Stimulating Hormone (TSH), taking thyroid hormone to bring the level of TSH done to low normal levels can help. This particular hormone goes up when you produce lower amounts of the active thyroid hormone, which is why lowering it makes sense. There are two forms, T3 and T4, which refers to how many iodine molecules are attached to the thyroid hormone.
Medications that have been shown to help Bipolar I depression include lithium, lamotrigine, and a few of the atypical antipsychotic medications such as quetiapine. Although these last medications are called "antipsychotics" they are used for other conditions such as Bipolar Disorder. This is analogous to using aspirin for many different things such as treating headaches or arthritis, reducing fever, or preventing heart attacks.
As usual, you should not try treating yourself if you have Bipolar depression; I strongly recommend that you seek guidance from your doctor. However, I hope this brief review helps you become more knowledgeable and ask more informed questions.
