summary: Researchers are leading a global clinical trial that suggests long-term use of modern antidepressants may reduce relapses of depression in people with bipolar disorder.
This challenges current clinical practice guidelines and could revolutionize how bipolar depression is treated worldwide. The study found that people who continued antidepressant treatment for more than a year were significantly less likely to have depression again.
These findings may lead to revision of current bipolar disorder treatment guidelines and provide life-saving treatment approaches for patients with bipolar disorder.
Important facts:
- This study is the world’s first randomized clinical trial investigating the duration of adjunctive antidepressant therapy for bipolar disorder and suggests that long-term treatment may help prevent depression from recurring.
- Analysis showed that patients who continued antidepressant treatment were 40% less likely to experience recurrent mood events and 59% less likely to experience depressive episodes compared to the placebo group.
- Because people with bipolar disorder experience depressive symptoms three times more often than manic symptoms, this study is of potential importance in reducing suicide rates associated with depressive episodes.
sauce: University of British Columbia
Treatment with newer antidepressants may help prevent recurring depressive episodes in people with bipolar disorder, according to an international clinical trial led by researchers at the University of British Columbia.
The results of this survey are today New England Journal of Medicinechallenges current clinical practice guidelines and has the potential to change how bipolar depression is managed globally.
“Treatment of depression in bipolar disorder is difficult, and depressive episodes can be highly devastating to patients and their families,” said UBC professor and director of psychiatry, who was involved in the study. said Dr. Lakshmi Yatham, lead author of .
“Reducing the risk of recurrence is important because it can give patients greater stability and ultimately allow them to return to activities they enjoy, significantly improving their quality of life.”
People with bipolar disorder experience extreme changes in their emotional state, alternating between intense periods of high (mania or hypomania) and low periods (depression). During a depressive episode, patients may experience sadness, hopelessness, and loss of interest or enjoyment in activities, in addition to sleep disturbances, appetite changes, and suicidal thoughts.
Adjunctive antidepressant therapy (prescribing antidepressants in combination with mood stabilizers and second-generation antipsychotics) is a strategy commonly used by clinicians to treat depressive episodes.
However, due to the lack of evidence and concerns that antidepressants can induce mania, mixed states, or rapid cycling between mania and depression, the duration of this treatment is hotly debated. It has been.
The practice guidelines for bipolar disorder management published by the Canadian Mood Anxiety Treatment Network (CANMAT) and the International Society for Bipolar Disorder (ISBD) currently recommend that antidepressant treatment be discontinued 8 weeks after remission of depression. ing.
“This is an area that has not been extensively researched and there is not much consensus among experts,” says Dr. Yartham. “Some studies show that up to 80 percent of patients have been on antidepressants for six months or longer.”
Now, results from the world’s first randomized clinical trial evaluating the duration of adjunctive antidepressant therapy suggest that extending treatment beyond current guidelines may help prevent depression from recurring. suggests.
The clinical trial was conducted at centers in Canada, South Korea, and India, and involved 178 bipolar I disorder patients who were in remission from a depressive episode after treatment with a modern antidepressant (escitalopram or bupropion XL). Patients were randomly assigned to continue antidepressant treatment for 52 weeks or to begin tapering off antidepressants at 6 weeks and switch to placebo at 8 weeks.
In the one-year study, 46 percent of patients in the placebo group experienced recurrent mood events, compared with only 31 percent of those who continued antidepressant treatment.
Although this primary outcome was not found to be statistically significant, comparisons also included relapses that occurred during the first 6 weeks of the study when both groups received the same treatment.
However, in analyzes after week 6, when the two groups differed in treatment, patients who continued antidepressant treatment were more likely to experience recurrent mood events compared with those who continued antidepressant treatment. They were 40 percent less likely and 59 percent less likely to experience a depressive episode. placebo group.
There were no significant differences in the incidence of manic episodes or adverse events between groups.
“From the time the two groups began receiving different treatments, we found significant benefits for patients who remained on antidepressants,” Dr. Yartham said.
Patients with bipolar I disorder experience depressive symptoms three times more often than manic symptoms. Previous studies have shown that depressive episodes are at least 18 times more likely to attempt suicide and die from suicide compared to manic episodes.
“Stabilizing the patient’s condition and preventing recurrence to keep them stable is critical and can literally save lives,” Dr. Yatam said.
“Future revisions of the Bipolar Disorder Guidelines will incorporate evidence from this study and contribute to changes in clinical practice about how antidepressants are used in the management of people with bipolar disorder. ”
The study was conducted in collaboration with UBC researchers and other research facilities in Canada, India and South Korea. It was supported by the Canadian Institutes of Health Research.
About this Bipolar Disorder and Psychopharmacology Research News
author: Alex Walls
sauce: University of British Columbia
contact: Alex Walls – University of British Columbia
image: Image credited to Neuroscience News
Original research: closed access.
“Adjunctive Antidepressant Maintenance Period in Bipolar I DepressionBy Lakshmi Yatam et al. NJEM
overview
Adjunctive Antidepressant Maintenance Period in Bipolar I Depression
Background
Antidepressants are used to treat acute depression in patients with bipolar I disorder, but their effectiveness as maintenance therapy after depression has remitted has not been well studied.
Method
We performed a multicenter, double-blind, randomization comparing maintenance treatment with adjuvant escitalopram or bupropion XL with discontinuation of antidepressant treatment in patients with bipolar I disorder who had recently remitted from a depressive episode. A placebo-controlled study was conducted. Patients were randomized 1:1 to continue antidepressant treatment for 52 weeks after remission or to switch to placebo after 8 weeks. The primary outcome assessed in the time-to-event analysis was any mood episode as defined by scores on scales measuring symptoms of hypomania or mania, depression, suicidal tendencies, and mood episode severity. . Additional treatment or hospitalization for mood symptoms. or has attempted or completed suicide. Primary secondary outcomes included time to manic, hypomanic, or depressive episode.
result
Of the 209 patients with bipolar I disorder who participated in the open-label treatment phase, 27 directly enrolled patients plus 150 in depression remission were enrolled in the double-blind phase. A total of 90 patients were assigned to continue prescribed antidepressant treatment for 52 weeks (52-week group), and 87 were assigned to switch to placebo at 8 weeks (8-week group). Due to recruitment delays and funding limitations, the trial was stopped before reaching full recruitment. At week 52, primary outcome events occurred in 28 (31%) of patients in the 52-week group and 40 (46%) in the 8-week group. The hazard ratio for time to mood episode for the 52-week group versus the 8-week group was 0.68 (95% confidence interval). [CI], 0.43 to 1.10. P=0.12 by log-rank test). A total of 11 patients (12%) in the 52-week group had mania or hypomania compared with 5 patients (6%) in the 8-week group (hazard ratio, 2.28; 95% CI, 0.86-6.08). Depression relapsed in 15 (17%) compared with 35 (40%) patients (hazard ratio, 0.43; 95% CI, 0.25 to 0.75). The incidence of adverse events he was similar in the two groups.
Conclusion
In a trial of patients with bipolar I disorder and a depressive episode in recent remission, adjuvant treatment with escitalopram or bupropion XL continued for 52 weeks was better than 8 weeks of treatment in preventing recurrent mood episodes. showed no significant effect. This trial was terminated early due to recruitment delays and funding limitations. (Funded by the Canadian Institutes of Health Research, ClinicalTrials.gov number, NCT00958633.open in new tab. )
