Editing Mood stabilizer (section)

==Relationship to antidepressants==
Most mood stabilizers are primarily antimanic agents, meaning that they are effective at treating [[mania]] and mood cycling and shifting, but are not effective at treating acute [[clinical depression|depression]]. The principal exceptions to that rule, because they treat both manic and depressive symptoms, are [[lamotrigine]], [[lithium carbonate]], [[olanzapine]] and [[quetiapine]]. There is a need for caution when treating bipolar patients with antidepressant medication due to the risks that they pose.<ref>Chris Aiken: [https://www.psychiatrictimes.com/view/antidepressants-bipolar-ii-disorder ''Antidepressants in Bipolar II Disorder''], May 14, 2019. In: psychiatrictimes.com</ref><ref name=Gitlin>{{cite journal | vauthors = Gitlin MJ | title = Antidepressants in bipolar depression: an enduring controversy | journal = International Journal of Bipolar Disorders | volume = 6 | issue = 1 | pages = 25 | date = December 2018 | pmid = 30506151 | pmc = 6269438 | doi = 10.1186/s40345-018-0133-9 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Viktorin A, Lichtenstein P, Thase ME, Larsson H, Lundholm C, Magnusson PK, Landén M | title = The risk of switch to mania in patients with bipolar disorder during treatment with an antidepressant alone and in combination with a mood stabilizer | journal = The American Journal of Psychiatry | volume = 171 | issue = 10 | pages = 1067–1073 | date = October 2014 | pmid = 24935197 | doi = 10.1176/appi.ajp.2014.13111501 | s2cid = 25152608 | hdl = 10616/42159 | hdl-access = free }}</ref>

{{See also|SSRI#Bipolar switch}}
Nevertheless, [[antidepressants]] are still often prescribed in addition to mood stabilizers during depressive phases. This brings some risks, however, as antidepressants can induce [[mania]] (increases risk by 34%),<ref>{{cite journal |last1=Patel |first1=Rashmi |title=Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study |journal=BMJ Open |date=2015 |volume=5 |issue=12 |pages=e008341 |doi=10.1136/bmjopen-2015-008341 |pmid=26667012 |pmc=4679886}}</ref> [[psychosis]] (relative risk not reported),<ref>{{cite journal |last1=Preda |first1=A |last2=MacLean |first2=RW |last3=Mazure |first3=CM |last4=Bowers MB |first4=Jr |title=Antidepressant-associated mania and psychosis resulting in psychiatric admissions. |journal=The Journal of Clinical Psychiatry |date=January 2001 |volume=62 |issue=1 |pages=30–3 |doi=10.4088/jcp.v62n0107 |pmid=11235925 }}</ref> cycle acceleration,<ref name=Gitlin/> and other disturbing problems in people with [[bipolar disorder]]—in particular, when taken alone. The risk of antidepressant-induced mania when given to patients concomitantly on antimanic agents is not known for certain but may still exist.<ref name=":0">Amit BH, Weizman A. Antidepressant Treatment for Acute Bipolar Depression: An Update. Depression Research and Treatment [Internet]. 2012 [cited 2013 Jul 18];2012:1–10. Available from: http://www.hindawi.com/journals/drt/2012/684725/</ref> SSRIs and bupropion appear to have lower chances of switching, while SNRIs and tricyclics are more likely to cause switching. A single large, population based study reports that the manic "switch" risk is not increased over regular mood stabilizer treatment when an antidepressant is combined with a mood stabilizer. When an antidepressant is used alone, the risk is about 3 times the regular value.<ref name=Gitlin/> Gitlin (2018) notes that "the potential issue of worsening suicidality in adolescents and young adults treated with antidepressants [...] both controversial and infrequently seen."<ref name=Gitlin/>

Equally critical is the question of whether adding antidepressant has any effect on bipolar depression. High-quality data is lacking in this field, and simply using different analytical approaches can lead to different conclusions. It's also possible that the effect depends on the mood stabilizer used: one study finds no effect when antidepressant is added to lithium or valporate, but some efficacy when it's added to atypical antipsychotics.<ref name=Gitlin/>