Impact of antidepressant continuation after acute positive or partial treatment response for bipolar depression: a blinded, randomized study.
OBJECTIVE
To assess long-term outcome in bipolar disorder, subjects were prospectively followed after receiving acute treatment for bipolar depression.


METHODS
Eighty-three outpatients with DSM-IV bipolar depression who were enrolled between March 1996 and November 2002 and were treated in a 10-week acute double-blind antidepressant treatment trial agreed to participate in a 1-year double-blind continuation of their medication. In the acute antidepressant treatment trial, subjects were treated with a mood stabilizer plus 1 of 3 randomly assigned antidepressants. Sixty-one subjects had attained an acute positive antidepressant response (50% improvement on the Inventory for Depressive Symptomatology [IDS] or 2-point improvement on the Clinical Global Impression for Bipolar Disorder [CGI-BP]) and 22 subjects achieved only acute partial improvement at the end of the 10-week acute trial. In the blinded continuation phase immediately following the acute trial, subjects continued on the same medications and were rated monthly for up to 1 year using the IDS, CGI-BP, and the Young Mania Rating scale.


RESULTS
At study endpoint, 42 (69%) of the 61 acute positive responders maintained positive response and 32 (53%) achieved remission. Compared to the acute positive responders, 6 (27%) of the 22 acute partial responders had achieved positive treatment response at study endpoint (p < .001). Eight acute positive responders (13%) and 5 acute partial responders (22%) developed mania.


CONCLUSIONS
Patients who achieve a positive acute antidepressant response to 10 weeks of antidepressant treatment adjunctive to a mood stabilizer will probably maintain response with the same continued treatment. Patients who achieve only a partial acute antidepressant response are less likely to further improve when the same treatment is sustained. The switch rate into mania for patients being treated with an antidepressant adjunctive to a mood stabilizer is not higher than the reported rate for patients on mood stabilizer monotherapy.
Altshuler
Lori L
LL
Department of Psychiatry, Veterans Affairs Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA. laltshuler@mednet.ucla.edu
Post
Robert M
RM
Hellemann
Gerhard
G
Leverich
Gabriele S
GS
Nolen
Willem A
WA
Frye
Mark A
MA
Keck
Paul E
PE
Kupka
Ralph W
RW
Grunze
Heinz
H
McElroy
Susan L
SL
Sugar
Catherine A
CA
Suppes
Trisha
T
D000208:Acute Disease; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy*; D016642:Bupropion / Q000627:therapeutic use*; D003511:Cyclohexanols / Q000627:therapeutic use*; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D020280:Sertraline / Q000627:therapeutic use*; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
D000928:Antidepressive Agents; D018692:Antimanic Agents; D003511:Cyclohexanols; D016642:Bupropion; D000069470:Venlafaxine Hydrochloride; D020280:Sertraline