Patients with bipolar depression who improve with modern antidepressants may benefit from continuing antidepressants instead of discontinuing them, according to the study.
The study has found that extending adjunctive antidepressants up to 52 weeks helps prevent depressive relapses, compared to discontinuation after eight weeks of remission, as per current guidelines.
The study was published in the New England Journal of Medicine on Thursday. The clinical trial involving 178 individuals was conducted at sites in Canada, India, and Korea. Most of the participants in the study were Indians.
Bipolar disorder is characterized by wild mood swings ranging from mania to depression. In the manic phase, one feels unusually happy, elated, or highly irritable, markedly overactive, highly energetic, and sleepless. The patient may have a sense of grandiose and paranoia and could turn aggressive. During the depressive phase, patients experience a lack of interest and pleasure in activities, and may feel hopeless, helpless, and worthless. They may be at times psychotic and may have a high suicide risk
Dr. YC Janardhan Reddy, a professor of psychiatry, Nimhans
The study was led by Dr. Lakshmi Yatham of the University of British Columbia (UBC) and Dr. YC Janardhan Reddy, a professor of Psychiatry at the National Institute of Mental Health and Neurosciences (Nimhans), Bengaluru. “It is the first randomized controlled trial of maintenance treatment with adjunctive antidepressants,” Dr. Reddy told TOI.
Currently, bipolar depression is treated with antimanic medications and antidepressants. As per guidelines, antidepressants are to be discontinued eight weeks after remission of depression.
Bipolar disorder, characterized by depression and mania, is prevalent in about 1% of the population. An individual with bipolar disorder is at least 18 times more susceptible to suicide deaths during the depression phase than in mania. “Bipolar depression can be severe and often associated with high suicide risk,” said Dr. Reddy. “While there are effective medications to treat and prevent acute mania, treatment and prevention of bipolar type of depression have been challenging despite the advent of many medications recently,” he said.
The study was supported by the Canadian Institute of Health Research.