The results of a new trial suggest that modern antidepressants might be effective for long-term treatment of some patients with bipolar disorder, despite current guidelines discouraging their use due to concerns about triggering manic episodes. The trial found that bipolar patients who remained on antidepressants for a year had fewer mood episodes compared to those who were switched to a placebo after two months.
The study, led by Dr. Lakshmi Yatham, the head of psychiatry at the University of British Columbia in Canada, aimed to address the common practice of prescribing antidepressants to bipolar patients, even though guidelines advise against it. Dr. Yatham, who was also the lead author of Canadian bipolar disorder treatment guidelines, highlighted that the concern has always been that antidepressants might switch people from depression to mania.
The trial enrolled 178 patients with bipolar disorder who had recently recovered from a depressive episode following treatment with a modern antidepressant. These patients were randomly assigned to either continue antidepressant treatment for 52 weeks or taper off the drugs after six weeks and switch to a placebo by eight weeks.
The trial didn’t meet its primary goal of showing a statistically significant benefit for using antidepressants long-term versus short-term due to a relatively small number of participants. However, when the data was analyzed more closely, differences emerged.
While the overall benefits were not statistically significant, a closer look at the data revealed that patients on long-term antidepressants experienced fewer mood relapses compared to those on the placebo. Notably, when analyzing the data from week six onwards, there was a statistically significant difference in the relapse of mood episodes between the two groups.
Furthermore, patients on long-term antidepressants had a lower rate of depressive events compared to the short-term group, which was statistically significant. On the other hand, there was a slightly higher risk of manic episodes in the long-term antidepressant group, but this increase was not statistically significant due to the small number of patients who experienced manic events.
Experts in the field noted that while these findings provide some support for the use of antidepressants in bipolar patients, they are unlikely to lead to an immediate change in treatment guidelines. They emphasize that if antidepressants are considered for bipolar disorder, they should be used in conjunction with mood-stabilizing agents like lithium, valproate, or antipsychotics.
This study suggests that while there might be some benefit to long-term use of antidepressants for bipolar patients, caution should be exercised, and these medications should be used in combination with other treatments to minimize potential risks. You May Find Useful Information On: What Happens If You Take Lamictal And Are Not Bipolar?