Mental Health, Brain Health and Substance Use
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Antidepressant medicines in individuals with a depressive episode in bipolar disorder

2023 updated

Fluoxetine, olanzapine, quetiapine, valproic acid (sodium valproate) or venlafaxine should be considered for people with bipolar depression. If fluoxetine or venlafaxine are chosen, they should be co-administered with a mood stabilizer (namely quetiapine, olanzapine, carbamazepine, valproic acid [sodium valproate], lithium).
Strength of recommendation: CONDITIONAL
Certainty of evidence: VERY LOW

2023 validated

Fluoxetine, olanzapine, quetiapine, valproic acid (sodium valproate) or venlafaxine should be considered for people with bipolar depression. If fluoxetine or venlafaxine are chosen, they should be co-administered with a mood stabilizer (namely quetiapine, olanzapine, carbamazepine, valproic acid [sodium valproate], lithium).
Strength of recommendation: CONDITIONAL
Certainty of evidence: LOW

[2012]

Recommendation(s)

Antidepressant medicines, always in combination with a mood stabilizer (lithium or valproate), may be considered in the treatment of moderate or severe depressive episodes of bipolar disorder. Selective serotonin reuptake inhibitors (SSRI; fluoxetine) should be preferred to tricyclic antidepressants (TCA).
Strength of recommendation: CONDITIONAL
Quality of evidence: LOW

Antidepressant treatment should begin at a low dose and be increased gradually if necessary.
Individuals should be monitored carefully for early symptoms or signs of manic symptoms. Antidepressant medication should be stopped soon after remission of depressive symptoms, while mood stabilizer should be continued.
Strength of recommendation: STRONG
Quality of evidence: LOW