Dear Dr. SerVaas: A few years ago, a psychologist told me that if people who had the least tendency for bipolar depression took antidepressants, it could kick them into being bipolar. My medical doctor agreed, Now, a relative is telling me that her psychiatrist said this is not so. My mother suffered from bipolar depression. I do not need antidepressants at this point but am concerned for other family members. Could you please find the answer for me?

B. Houseworth
Crete, Illinois

Dear Reader: Some people with bipolar illness are particularly sensitive to antidepressants and may respond with mania or rapid cycling (switching quickly from depression to mania and back again), advises bipolar expert Dr. John Nurnberger, director of the Indiana University Institute of Psychiatric Research. Dr. Nurnberger continues:

"For this reason, we never treat persons with bipolar disorder with antidepressants unless they are first on a mood-stabilizing medicine such as lithium, valproate, carbamazepine, lamotrigine, or olanzapine. For people with a family history of bipolar disorder, a careful evaluation should precede any use of an antidepressant.'

Dr. Nurnberger explains that people with depression may benefit from adding lithium to their current medicines.

"Lithium augmentation is well established to be effective in a number of cases when the original antidepressant is not effective, or only partially effective. This holds true for patients with unipolar depression as well as bipolar illness. We also use thyroid hormone or sometimes methylphenidate as augmenting agents. A response is usually seen within two weeks."

A study published in the December 2003 issue of Pharmacopsychiatry suggests that lithium augmentation promotes the smooth flow of chemical messengers in the brain and nervous system.