Continuing long-term treatment with modern antidepressants may help reduce the risk of relapsing into depression in patients with bipolar disorder.
Treating depression in bipolar depression is usually challenging. And during depressive episodes is when suicidal behavior is more likely. When treatment for mania is effective and the patient is stabilized, there's a chance of relapsing into depressive episodes at some point. This relapse can wreck the overall treatment because stability helps patients recover better and get back to the activities they enjoy. Hence, preventing relapse is crucial when treating bipolar disorder.
Why relapse is common in patients with bipolar disorder
People with bipolar disorder often undergo antidepressant adjunctive therapy. Adjunctive therapy involves using antidepressants alongside mood stabilizers such as lithium and/or antipsychotic medications. While mood stabilizers calm the manic symptoms, antidepressants work for the depressive part of the spectrum.
Problem is, the duration of the therapy is a challenge because there are concerns about antidepressants triggering mania in bipolar disorder patients over time. (Before now, there was not much research on this.) So, clinicians usually stop giving antidepressants after eight weeks of the remission of depression, as recommended by the International Society for Bipolar Disorders.
Now, research shows that continuing antidepressants beyond eight weeks of depression remission can reduce the risk of relapsing into depression by 59%.
The study involved 178 bipolar I disorder patients in remission from depression. Each patient was on modern antidepressants (escitalopram or bupropion XL). While some continued using antidepressants for over a year, others reduced their dose at week 6 and stopped at week 8 before starting a placebo.
And here's what the researchers discovered.
From the sixth week onward, patients who continued antidepressants were 59% less likely to relapse into depression and 40% less likely to experience any mood symptoms than those who stopped at week 8.
Although there was no significant difference in the rate at which both groups experienced manic episodes, this is big news in the world of bipolar depression treatment.
That's because, in bipolar disorder, the depressive symptoms episodes are usually more treatment-resistant than manic episodes.
What's more, bipolar I disorder patients are three times more likely to experience depressive episodes than mania. These episodes can be life-threatening, riddled with feelings of hopelessness and suicidal thoughts.
Hopefully, the current guidelines on the duration of antidepressant adjunctive therapy can be modified to allow for more long-term use.
Preventing relapse can be the key to helping bipolar disorder patients get back on their feet again.
Full research here.
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