Does Sertraline treat bipolar disorder? (3+ alternates)

In this article, we will answer the question, “Does Sertraline treat bipolar disorder?”. We will discuss what research has to say in this regard, potential benefits and drawbacks regarding the usage of Sertraline, and alternative treatment options for bipolar disorder.

Does Sertraline treat bipolar disorder?

No, Sertraline does not treat bipolar disorder, but it may be used as an adjunctive therapy to manage bipolar-related depression. Sertraline is not approved by the FDA for the treatment of bipolar disorder, however, this medication is prescribed to some individuals who may benefit from its effects.

Sertraline (also known as Zoloft), is an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRIs). This medication is approved by the FDA for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD), premenstrual dysphoric disorder (PMDD), social anxiety disorder (SAD) and posttraumatic stress disorder (PTSD) (1).

Sertraline has been used ‘off-label’ by medical professionals in the treatment and management of binge eating disorder, bulimia nervosa, body dysmorphic disorder, generalised anxiety disorder (GAD), and premature ejaculation It has been used as an adjunct in the management of bipolar disorder symptoms (2,3).

Bipolar disorder (also known as manic depression), is a type of mental illness that may cause a drastic shift in mood, energy, and concentration of individuals suffering from this disorder. These shifts can make day-to-day activities difficult and they may become a mental burden (4).

There are three types of bipolar disorders and all of them are characterised by episodes of mood elevation, depression, and changes in energy levels (4).

Sertraline has been used in bipolar disorder to manage the depressive symptoms of the illness. However, precautions should be taken as it can trigger manic episodes in such individuals. If you have been prescribed this medication for your mental illness, you should keep an eye on any unusual symptoms (5).

What does research suggest?

Studies on Sertraline for the management of depressive symptoms of bipolar disorder as well as evidence of Sertraline causing manic episodes in individuals have been published.

A research study assessing the use of antidepressants in bipolar disorder stated that many healthcare professionals use antidepressant medications like Sertraline, to manage depressive symptoms in individuals (6).

Another study examining antidepressant-related mood elevations in bipolar disorder concluded that the risk of mood elevations in individuals being given antidepressants like Sertraline for bipolar disorder is much greater in bipolar I disorder as compared to bipolar II disorder (7).

Another study assessing the individuals for switch rates to manic episodes, while taking Lithium, Sertraline, or a combination of both medications did not find any difference in the occurrence of manic episodes, whether the individual was on antidepressant therapy or not (8).

What are the pros and cons of Sertraline in bipolar depression?

Some benefits and drawbacks of using Sertraline for bipolar disorder-related depression are described below.

Benefits Drawbacks
Improves symptoms – Sertraline can improve symptoms of bipolar disorder. Occurrence of a manic or hypomanic episode- If Sertraline is not taken with a mood stabiliser, it may cause manic or hypomanic episodes in bipolar individuals.
Treats bipolar depression – Bipolar depression can be effectively managed by Sertraline.  
Improves mood – If depression is effectively managed, it can help in improving the mood of the individual undergoing treatment.  

What alternatives are available for bipolar depression?

Healthcare providers may prescribe antidepressants like Sertraline, Fluvoxamine, or Venlafaxine to help with bipolar-related depression. However, if Sertraline does not work there are alternatives available that may be more effective. The FDA has approved the following medications for the management of bipolar-related depression (8, 9):

  • Olanzapine-Fluoxetine combination
  • Quetiapine
  • Lurasidone

Keep in mind that any such medication should be taken on the recommendation of your doctor. If you have been prescribed Sertraline to manage your bipolar-related depression, and you think it might not be working effectively, you should consult your healthcare provider and discuss your concerns.

You should never start or stop any medication without consulting with your healthcare provider. Doing any such thing may cause more harm than good and may result in many unwanted side effects.

Are there any complementary therapies for bipolar disorder?

Alternative treatments and complementary therapies for bipolar disorder are described below (10).

Therapy Details
Psychotherapy Psychotherapy is for the patient as well as family members. The individuals, caregivers, and loved ones are educated about the condition, the differences in personalities of the individual, and how to effectively manage an episode. 
Interpersonal and social rhythm therapy (IPSRT) Educating individuals on how to cope with their episodes during a social gathering is the main focus of IPSRT. Teaching proper coping mechanisms and developing healthy social rhythms can help the individual manage episodes in a better way.
Cognitive behaviour therapy (CBT) Cognitive behaviour skills for coping with bipolar depression can be very helpful in managing depressive symptoms.
Electroconvulsive therapy (ECT) ECT is a brain stimulation procedure performed by electric currents. This therapy improves the symptoms of bipolar disorder.
Repetitive transcranial magnetic stimulation (rTMS) This procedure uses magnetic pulses to stimulate the brain and relieve bipolar-related depression.
Bright light therapy (BLT) BLT is normally used in individuals who experience seasonal affective disorder along with bipolar disorder. BLT can decrease the severity of bipolar depression.
Family-focused interventions Family and loved ones can help in managing episodes of mania or depression, so they should be educated in various coping mechanisms as well.
Support groups Support groups can be of great help. Knowing that you are not going through this alone and help is always available can be relieving for the individuals.
Rehabilitation Rehabilitation programs may be individually modeled according to the needs of the individual.
Lifestyle and dietary modifications Patients with bipolar-associated depression may be at a greater risk for metabolic and cardiovascular problems. So, keeping a healthy lifestyle and diet is crucial to help reduce the incidence of such side effects.

Sertraline as an option for bipolar disorder treatment

In my experience as a pharmacist and according to research, Sertraline is not recommended for monotherapy of bipolar disorder. However, it may be used as an adjunctive medication to help manage symptoms of bipolar-related depression. If prescribed in such a situation, Sertraline needs to be continuously monitored due to its risk of triggering manic episodes.

Non-pharmacological therapies can also help manage bipolar-related depression, much more effectively if given along with pharmacological treatments. Therapies like CBT, ECT, IPSRT, BLT, and rTMS can help individuals manage their symptoms. Support groups, rehabilitation programs, and various lifestyle modifications can also help individuals with bipolar depression.

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