Prolonged Antidepressant Treatment No Benefit in Bipolar I Disorder

THURSDAY, Aug. 3, 2023 (HealthDay News) -- For patients with bipolar I disorder who had recently had remission of a depressive episode, adjunctive treatment with escitalopram or bupropion XL that continues for 52 weeks does not show a significant benefit compared with treatment for eight weeks, according to a study published in the Aug. 3 issue of the New England Journal of Medicine.

Lakshmi N. Yatham, M.B., B.S., from the University of British Columbia in Vancouver, Canada, and colleagues conducted a multisite, double-blind trial of maintenance of treatment with adjunctive escitalopram or bupropion XL in patients with bipolar I disorder who had recently had remission of a depressive episode. Participants were randomly assigned to continue treatment with antidepressants for 52 weeks after remission or switch to placebo at eight weeks (90 and 87 patients, respectively).

Due to slow recruitment and funding limitations, the trial was stopped before full recruitment. The researchers found that 31 and 46 percent of patients in the 52-week and eight-week groups, respectively, had a primary outcome event of any mood episode. The hazard ratio for time to any mood episode was 0.68 (95 percent confidence interval, 0.43 to 1.10) in the 52-week versus eight-week group. Overall, 12 and 6 percent of patients in the 52-week and eight-week groups, respectively, had mania or hypomania (hazard ratio, 2.28; 95 percent confidence interval, 0.86 to 6.08) and 17 and 40 percent, respectively, had recurrence of depression (hazard ratio, 0.43; 95 percent confidence interval, 0.25 to 0.75).

"Continuing adjunctive antidepressant therapy for 52 weeks as compared with discontinuing antidepressants at eight weeks was not more beneficial with regard to the primary outcome of the occurrence of any mood episode," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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