The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression: a retrospective chart review.
BACKGROUND
Current treatment guidelines recommend discontinuation of an antidepressant within 3 to 6 months after remission of depression in patients with bipolar illness. Yet few studies directly compare the impact of antidepressant discontinuation versus antidepressant continuation on the risk for depressive relapse in patients with bipolar disorder who have been successfully treated for a depressive episode.


METHODS
In a retrospective chart review, patients with DSM-IV bipolar disorder who were treated for an index episode of depression by adding antidepressant medication to ongoing mood stabilizer medications were identified. The risk of depressive relapse in 25 subjects who stopped antidepressant medications after improvement was compared with the risk of depressive relapse in 19 subjects who continued antidepressants after improvement.


RESULTS
Termination of antidepressant medication significantly increased the risk of a depressive relapse. Antidepressant continuation was not significantly associated with an increased risk of mania.


CONCLUSIONS
While this study may have been limited by the retrospective nature of the chart review, nonrandomized assignment of treatment, and reliance on unstructured progress notes, it suggests that antidepressant discontinuation may increase the risk of depressive relapse in some patients with bipolar disorder. Further research is needed to clarify whether maintenance antidepressant treatment may be warranted in some patients with bipolar disorder, especially in those with frequent recurrent depressive episodes.
Altshuler
L
L
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA. LAltshuler@mednet.ucla.edu
Kiriakos
L
L
Calcagno
J
J
Goodman
R
R
Gitlin
M
M
Frye
M
M
Mintz
J
J
D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D003866:Depressive Disorder / Q000209:etiology / Q000517:prevention & control; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007099:Imipramine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008094:Lithium / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008499:Medical Records; D010919:Placebos; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000517:prevention & control; D016019:Survival Analysis
D000928:Antidepressive Agents; D010919:Placebos; D008094:Lithium; D007099:Imipramine