Antidepressants may benefit individuals with bipolar disorder when used for an extended period.

Antidepressants may benefit individuals with bipolar disorder when used for an extended period.

Antidepressants for Long-term Treatment of Bipolar Disorder: New Trial Provides Insights

Modern antidepressants could potentially prove effective for long-term treatment of some patients with bipolar disorder, according to a recent trial. These findings challenge the prevailing guidelines that discourage the use of antidepressants in bipolar patients due to concerns about triggering manic episodes. Lead researcher Dr. Lakshmi Yatham, head of psychiatry at the University of British Columbia, emphasizes that although the trial doesn’t provide definitive support for antidepressants, it should convince skeptics that continuing antidepressant treatment is beneficial for certain patients.

Depressive episodes pose a significant risk of suicide for bipolar patients. In fact, suicide attempts and deaths occur at least 18 times more frequently during depressive episodes compared to manic episodes. Despite existing guidelines discouraging their use, recent surveys indicate that nearly three in five bipolar patients are being prescribed antidepressants. The study was initiated to evaluate the effectiveness and safety of long-term antidepressant use in this particular patient group.

The concerns regarding antidepressants triggering manic episodes or causing rapid cycling among bipolar patients are based on the effects observed with older tricyclic antidepressants. However, the researchers argue that modern antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may be more effective, especially when combined with mood-stabilizing drugs aimed at managing manic episodes.

In the trial, 178 patients with bipolar disorder who had recently recovered from a depressive episode were enrolled. They were randomly assigned to one of two groups: continuing antidepressant treatment for 52 weeks or tapering off the drugs at six weeks and switching to a placebo by eight weeks. While the study failed to meet its primary goal of showing a statistically significant long-term benefit, further analysis revealed that patients who remained on antidepressants beyond the initial eight weeks experienced fewer relapses of mood episodes.

More specifically, during the period from week six onwards, 27% of patients in the long-term antidepressant group relapsed, compared to 45% in the short-term group—a statistically significant difference. Additionally, the study found that patients on long-term antidepressants had a lower risk of depressive episodes (17% versus 40% in the short-term group, also statistically significant). Although there was a slightly increased risk of manic episodes (12% versus 6% in the short-term group), the number of patients experiencing mania was small and statistically insignificant.

• Exercise may help alleviate fatigue in people with MS.
• Aerobic exercise may relieve pain in ovarian cancer survivors.
• Sweetened beverages linked to higher risk of liver cancer and fatal...

In summary, the trial demonstrates that while the overall statistical significance is lacking, long-term antidepressant treatment may be beneficial for certain bipolar patients. Although this finding may not result in an immediate change to practice guidelines, it provides support for clinicians who have already been prescribing antidepressants to bipolar patients. It is crucial to note that antidepressants should not be used as the sole treatment; they should always be combined with mood-stabilizing agents like lithium, valproate, or antipsychotics to prevent the occurrence of manic episodes.

QUESTION: Another term that has been previously used for bipolar disorder is ___________________. See Answer

Experts believe that further research with a larger sample size is necessary to draw more definitive conclusions. Until then, clinicians should carefully weigh the risks and benefits and individualize their treatment approaches based on the unique needs of each bipolar patient.

The study was published in the New England Journal of Medicine on August 3, 2023.

Sources: – Source: Modern antidepressants could be effective for long-term treatment of some patients with bipolar disorder, a new trial suggests, UPI – Source: Antidepressants May Help Some Patients With Bipolar Disorder, HealthDay Reporter