Antidepressant choice for bipolar depression

When choosing an antidepressant for combination therapy, consider patient factors and drug properties as outlined for their use in major depression (see here). Of the antidepressant classes, selective serotonin reuptake inhibitors (SSRIs) are the least likely to induce a manic episode or provoke a rapid cycling pattern, whereas serotonin noradrenaline reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are most likely to cause these effects. While SSRIs are therefore usually the preferred antidepressant class for combination therapy, not all patients respond to SSRIs so use of an SNRI, TCA or MAOI may be considered (see Nonresponse to treatment of bipolar depression).