Does sertraline treat bipolar disorder? (3 potential risks)
By
Ivan Kahwa
| Reviewed by
Ivan Kahwa
The contents of this article are fact-based except otherwise stated within the article.
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Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
Reviewer bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss whether sertraline can be used to treat bipolar disorder. We will talk about some research studies and discuss factors that can affect the treatment of bipolar disorder while taking sertraline. We will also talk about some management strategies for bipolar disorder.
Does sertraline treat bipolar disorder?
Sertraline can be used to manage bipolar depression, but it is not efficient enough to manage bipolar disorder on its own. Sertraline is a selective serotonin reuptake inhibitor primarily used for depression, anxiety, obsessive-compulsive disorder (OCD), and related mental health conditions (1,2).
It is not approved by the FDA for the treatment of bipolar disorder (2). However, it can be paired with the approved antipsychotics to manage both bipolar disorder and depression. This combination can help patients with good symptomatic management and help manage their overall mental health.
However, sertraline is a prescription medication and is not a good choice for bipolar disorder. Sertraline monotherapy can sometimes exacerbate bipolar symptoms, which could require immediate medical attention.
So, make sure you do not take sertraline solely for managing bipolar symptoms without consulting your doctor. If you have bipolar disorder comorbid with depression, your doctor will prescribe a good combination of an antidepressant and a compatible antipsychotic to help manage your condition safely and effectively.
What does research suggest?
Several research studies have discussed the use of sertraline in patients with mood disorders, including bipolar symptoms. Some research studies have indicated that sertraline can be used to manage bipolar depression and some other mood-related symptoms (3).
Research also suggests combination therapy with sertraline and another antipsychotic for the improvement of multiple symptoms associated with such mental health conditions (4).
However, research shows that sertraline can induce hypomania in people or unmask underlying bipolar symptoms (5). This can help with the diagnosis of bipolar disorder, but sertraline monotherapy is not effective for it as it can trigger mania and psychosis in certain individuals.
What are the risks associated with the use of sertraline for bipolar disorder?
Using sertraline alone for bipolar disorder is associated with some potential risks, including:
Worsening of bipolar disorder
Using sertraline alone to treat bipolar disorder may lead to a worsening of symptoms. It’s because sertraline primarily influences serotonin levels (1), and in bipolar disorder, the balance of neurotransmitters is much more complicated than that and involves other chemicals as well.
Relying solely on sertraline might not adequately help the specific mood fluctuations seen in bipolar disorder.
Mood swings
Sertraline, as an antidepressant, can stabilise mood, but in bipolar disorder, the characteristic mood swings include both depressive and mood changes. This is why people with bipolar symptoms who solely take sertraline can experience severe mood swings.
Mania
Bipolar disorder involves manic episodes characterised by elevated mood, increased energy, and impulsive behaviour. Sertraline, if not carefully monitored and balanced with mood stabilisers, could potentially trigger or exacerbate manic episodes.
What to do if your bipolar disorder worsens after taking sertraline?
If your bipolar disorder worsens after taking sertraline or if it triggers mania, you must seek medical attention as soon as possible. Some people may take sertraline for depression without knowing that they have bipolar disorder.
This is one of the main reasons why some people feel their symptoms getting worse after taking sertraline or another SSRI. This doesn’t mean that sertraline is not helping you or your body is not adjusting to it; it means that you have an underlying, undiagnosed condition that requires more than sertraline.
This is why proper diagnosis is essential as it sets the ground for the best possible treatment strategy to help your symptoms. So, if you’re taking sertraline but you experience severe mood swings, anger outbursts, paranoia, or other psychotic symptoms, you need to discuss this with your provider.
Your doctor will monitor your symptoms, diagnose any underlying cause of your sudden mood changes, and prescribe a suitable antipsychotic if you indeed have bipolar disorder. However, it is important to note that you should not make any swift changes to your treatment plan.
If you have been taking sertraline for a while and feel unusual, you should discuss it with your doctor instead of discontinuing the medication abruptly. Doing so can trigger withdrawal symptoms, which can vary from person to person.
How is bipolar disorder managed in clinical settings?
The clinical management of bipolar disorder includes the following medications and therapies: (6)
Medications
- Mood stabilisers: Drugs like lithium are commonly used to stabilise mood and prevent both depressive and manic episodes.
- Antipsychotics: Medications such as olanzapine or quetiapine may be prescribed to manage symptoms during manic episodes.
- Antidepressants: In some cases, cautiously prescribed antidepressants like fluoxetine may be added, but their use is typically accompanied by mood stabilisers to prevent triggering manic episodes.
- Anticonvulsants: Drugs like valproate or lamotrigine may be utilised for mood stabilisation.
Combination therapies
- Lithium with antipsychotics: This combination is often effective in preventing severe mood swings.
- Lithium with antidepressants: When depression is a prominent concern, combining lithium with carefully monitored antidepressants may be considered.
- Lamotrigine with mood stabilisers: Lamotrigine is sometimes added to existing mood stabilisers for better depressive symptom management.
Behavioural therapies
- Cognitive-behavioural therapy (CBT): CBT is effective in helping individuals recognize and modify harmful thought patterns and behaviours associated with bipolar disorder.
- Psychoeducation: Educating individuals and their families about the nature of bipolar disorder, its triggers, and coping strategies is important.
- Interpersonal and social rhythm therapy (IPSRT): This therapy focuses on stabilising daily routines and sleep patterns, which are important in managing bipolar symptoms.
As a pharmacist, I have seen people struggling with both depression and bipolar disorder. However, these conditions do have good medications now to manage them. Yes, the effects can vary from person to person, as each individual is unique and can respond differently to such medications.
However, Your doctor will work closely with you to determine the best possible treatment strategy for your symptoms which can help manage your mental health safely and effectively.
References
- Singh HK, Saadabadi A. Sertraline. 2023 Feb 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31613469. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547689
- The Food and Drug Administration (FDA). HIGHLIGHTS OF PRESCRIBING INFORMATION. ZOLOFT (sertraline hydrochloride) tablets, for oral use. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019839s74s86s87_20990s35s44s45lbl.pdf
- Amit BH, Weizman A. Antidepressant treatment for acute bipolar depression: an update. Depress Res Treat. 2012;2012:684725. doi: 10.1155/2012/684725. Epub 2012 Jan 27. PMID: 22319648; PMCID: PMC3272786. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272786/
- Altshuler LL, Sugar CA, McElroy SL, Calimlim B, Gitlin M, Keck PE Jr, Aquino-Elias A, Martens BE, Fischer EG, English TL, Roach J, Suppes T. Switch Rates During Acute Treatment for Bipolar II Depression With Lithium, Sertraline, or the Two Combined: A Randomised Double-Blind Comparison. Am J Psychiatry. 2017 Mar 1;174(3):266-276. doi: 10.1176/appi.ajp.2016.15040558. Epub 2017 Jan 31. PMID: 28135846. https://pubmed.ncbi.nlm.nih.gov/28135846/
- Mendhekar DN, Gupta D, Girotra V. Sertraline-induced hypomania: a genuine side-effect. Acta Psychiatr Scand. 2003 Jul;108(1):70-4. doi: 10.1034/j.1600-0447.2003.00080.x. Erratum in: Acta Psychiatr Scand. 2003 Dec;108(6):466. PMID: 12807380. https://pubmed.ncbi.nlm.nih.gov/12807380/
- Jain A, Mitra P. Bipolar Disorder. 2023 Feb 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32644424. https://www.ncbi.nlm.nih.gov/books/NBK558998