Continued treatment with modern antidepressants could help prevent patients with bipolar disorder from relapsing into a depressive episode, results from an international clinical trial led by researchers at the University of British Columbia, Canada, reveal.
Bipolar disorder is characterised by extreme changes in one’s emotional state that cycles through periods of intense highs (mania or hypomania) and lows (depression). Patients are prescribed antidepressants alongside mood stabilisers and/or antipsychotic medications as treatment.
However, the duration for prescribing antidepressants after depression subsides, which is part of the maintenance treatment to prevent the patient from relapsing into a depressive phase, is hotly debated. This is due to a lack of evidence and concerns that antidepressants may induce mania, mixed states or rapid cycling between mania and depression.
While Canadian guidelines currently recommend a duration of eight weeks after remission of depression, the Indian Psychiatric Society makes no explicit duration recommendation.
The trial results suggesting extending the treatment period beyond current guidelines challenge current clinical practice guidelines and could change how bipolar depression is managed globally. They are published in the New England Journal of Medicine and the trials were conducted at Canadian, South Korean and Indian sites.
“Some studies have shown that up to 80 per cent of patients continue receiving antidepressants for six months or longer,” said Lakshmi Yatham, professor and head of the department of psychiatry at the university, and the study’s lead author.
The study included 178 patients with bipolar I disorder in remission from a depressive episode following treatment with modern antidepressant drugs. They were randomly assigned to either continue antidepressant treatment for 52 weeks or begin tapering off antidepressants at six weeks and switch to placebo at eight weeks.
At the end of the year-long study, 46 per cent of patients in the placebo group experienced a relapse of any mood event, compared to only 31 per cent in the group with continued antidepressant treatment. This comparison included relapses occurring in the study’s first six weeks when treatment was the same for both groups.
However, analysing the results from the sixth week and when treatments started to differ, patients that continued antidepressant treatment were found to be 40 per cent less likely to experience a relapse of any mood event.
Further, they were found to be 59 per cent less likely to experience a depressive episode relative to the placebo group.
Feelings of sadness, hopelessness and loss of interest in activities, along with sleep troubles, appetite changes and suicidal thoughts are characteristic of depressive episodes.
“Reducing the risk of relapse is important because it can provide patients with a great deal of stability that ultimately lets them get back to the activities they enjoy and can greatly improve their quality of life,” said Yatham.
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