Health & Medicine, Canada (Commonwealth Union) – A global clinical trial, spearheaded by University of British Columbia (UBC) researchers, has unveiled that administering contemporary antidepressants may provide a preventive shield against relapses into depressive episodes for individuals grappling with bipolar disorder.
Presented in in a recent edition of the New England Journal of Medicine, the study outcomes challenge established clinical protocols and have the potential to reshape the global landscape of managing bipolar depression.
“Treating depression in bipolar disorder is challenging and the depressive episodes can be quite devastating for patients and their families,” explained Dr. Lakshmi Yatham, who is a professor that heads the department of psychiatry at UBC, and the lead author of the study. “Reducing the risk of relapse is important because it can provide patients with a great deal of stability that ultimately lets them get back to the activities they enjoy and can greatly improve their quality of life.”
Individuals contending with bipolar disorder undergo drastic fluctuations in their emotional equilibrium, oscillating between periods of elevated euphoria (mania or hypomania) and profound despondency (depression). When gripped by depressive phases, patients grapple with sentiments of melancholy, despair, and a diminished capacity for deriving satisfaction from activities. Sleep disturbances, appetite alterations, and even contemplations of self-harm can also manifest.
The approach of adjunctive therapy involving antidepressants, wherein these medications are administered alongside mood stabilizers and/or second-generation antipsychotic drugs, is a prevalent method employed by medical professionals to address these depressive episodes. Yet, the duration for which this therapy should persist remains a subject of intense discourse. The absence of substantial evidence and concerns about the potential for antidepressants to precipitate manic episodes, mixed states, or rapid shifts between mania and depression contribute to this debate.
Researchers pointed out that currently, the guidelines delineated by the Canadian Network for Mood and Anxiety Treatments (CANMAT) and the International Society for Bipolar Disorders (ISBD), dictating the management of bipolar disorder, advocate for the discontinuation of antidepressant treatment after eight weeks of depression remission.
“It’s an area that hasn’t been widely studied and there is not a lot of consensus among experts,” added Dr. Yatham. “Some studies have shown that up to 80 per cent of patients continue receiving antidepressants for six months or longer.”
New findings from the inaugural randomized clinical trial examining the extension of adjunctive antidepressant therapy propose that prolonging the treatment duration beyond existing guidelines could offer a potential safeguard against the recurrence of depressive episodes.
This groundbreaking clinical trial unfolded across sites in Canada, South Korea, and India and involved 178 participants grappling with bipolar I disorder. These individuals had achieved remission following a depressive episode with the aid of contemporary antidepressant medications (escitalopram or bupropion XL). The participants were arbitrarily assigned to one of two tracks: either maintaining antidepressant treatment for a span of 52 weeks or gradually tapering off antidepressants at the six-week mark, transitioning to a placebo at the eighth week.
During the comprehensive year-long study, it was observed that 46 percent of patients in the placebo cohort experienced a relapse of a mood-related event. In contrast, the group that continued with antidepressant treatment exhibited a lower relapse rate, standing at 31 percent. While this principal outcome did not attain statistical significance, this comparison encompassed relapses that transpired within the initial six weeks, a period when both cohorts were subjected to identical treatment protocols.
However, a pivotal distinction emerged in the analysis from the sixth week onward, a juncture when the treatment trajectories for the two groups diverged. Notably, those who continued to receive antidepressant treatment displayed a 40 percent reduced likelihood of encountering a relapse in any mood-related event, alongside a noteworthy 59 percent diminished likelihood of succumbing to a depressive episode, in comparison to their counterparts administered placebos. Discrepancies in the rate of manic episodes or adverse events between the two groups were not statistically substantial.
