Why are antidepressants contraindicated in Bipolar Disorder?

Antidepressants are contraindicated in bipolar disorder primarily because they can lead to mania. In individuals with bipolar disorder, especially those with a history of manic episodes, the introduction of antidepressants can precipitate a switch from depressive episodes to manic or hypomanic episodes. The underlying mechanism is believed to be related to the way these medications alter neurotransmitter levels, particularly serotonin and norepinephrine, which can destabilize mood regulation in someone who is predisposed to manic episodes.

The risk of inducing manic episodes makes the careful management of bipolar disorder crucial, often requiring mood stabilizers as a first-line treatment approach. This is essential in order to maintain mood stability and prevent oscillations between depression and mania, which can significantly impair functioning and quality of life.

Other potential considerations such as sedation or cost do not directly address the critical aspect of mood destabilization that occurs when antidepressants are used without adequate mood stabilization in place.