Extending Hope: Prolonged Antidepressant Treatment in Bipolar Disorder
Published September 2023
By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
Staff Research and Content Writer
© Copyright – SUD RECOVERY CENTERS – A Division of Genesis Behavioral Services, Inc., Milwaukee, Wisconsin – September 2023 – All rights reserved.
A new study could revolutionize the way we treat bipolar disorder.
What is bipolar disorder?
Bipolar disorder is a mental illness that causes extreme mood swings. Patients cycle through periods of intense emotional highs (mania or hypomania) and lows (depression).
When we think of bipolar disorder, the first thing that comes to mind is often the “manic” side, wherein a person experiences a very “up” mood and energetic, frantic behavior. However, people with bipolar disorder experience depressive episodes three times more often than they experience manic episodes. And these depressive episodes are just as harmful to their health and well-being. People with bipolar disorder experience suicidal attempts and deaths by suicide at a rate 18 times higher during their depressive episodes than during their manic episodes. Safe and effective treatment for the depressive side of bipolar disorder is quite literally life-saving.
What is the current treatment for depression in patients with bipolar disorder?
Providers often prescribe antidepressants to treat acute depression in patients with bipolar disorder. The use of antidepressants in combination with the mood stabilizers or antipsychotic medications used to treat their bipolar disorder is referred to as antidepressant adjunctive therapy.
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Clinical practice guidelines recommend that patients discontinue using this antidepressant once they have been in remission from their depression for at least eight weeks. However, little is known about how well this treatment works for preventing depressive relapses.
What did this study do?
Researchers at the University of British Columbia conducted a randomized clinical trial comparing the standard treatment for depression in patients with bipolar disorder to a an extended duration treatment. The study aimed to understand better the efficacy and safety of treating patients with antidepressants longer than current guidelines recommend.
What were the results?
The results of this study were mixed. Upon initial analysis, it did not appear that the longer duration of treatment was beneficial in preventing depressive relapse. The relapse rates between the control group (46%) and the treatment group (31%) were not statistically significant, meaning there was no clear benefit to a longer duration of treatment.
However, the researchers conducted another analysis excluding relapse events in the first six weeks of treatment. Patients in both groups received the same treatment during these first six weeks. By excluding these first six weeks, the researchers could more accurately compare the differences in the two treatment durations.
Based on this analysis, patients who continued antidepressant treatment for 52 weeks were 40 percent less likely to experience a relapse of any mood event compared to those treated for eight weeks. They were also 59 percent less likely to experience a depressive episode during the study. Specifically, 31 percent of patients in the control (8-week) group had a depressive episode within the 52-week study period compared to only 17 percent of the treatment (52-week) group.
Dr. Yatham, lead author of the study, summarizes this finding in a news piece for the UBC Faculty of Medicine News:
“From the point where the two groups began receiving different treatments, we see a significant benefit for patients who continued treatment with antidepressants,”
There was no significant difference in the rate of manic episodes or the rate of adverse events between groups. The study found that both durations of adjunct antidepressant treatment were equally safe, and few people discontinued treatment from either group due to adverse side effects. This finding eased the concern that extended antidepressant treatment could induce mania or rapid mood cycling.
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What are the implications of these findings?
This study found that adjunct antidepressant treatment for patients with bipolar disorder is safe and does not lead to serious adverse effects or a worsening of patients’ bipolar disorder.
Lakshmi N. Yatham, Shyam Sundar Arumugham, Muralidharan Kesavan, et al. “Duration of Adjunctive Antidepressant Maintenance in Bipolar I Depression.” New England Journal of Medicine, 2023; 389 (5): 430 DOI: 10.1056/NEJMoa2300184
Modern antidepressants may reduce risk of relapse for patients with bipolar depression. UBC Faculty of Medicine. Published August 3, 2023. Accessed from: https://www.med.ubc.ca/news/modern-antidepressants-may-reduce-risk-of-relapse-for-patients-with-bipolar-depression/