Does sertraline treat bipolar disorder? (3 potential risks)
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.
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.
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)
- 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.
- 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.
- 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.
- 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