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.
Department of Psychiatry, Veterans Affairs Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA. laltshuler@mednet.ucla.edu
Lori L
LL
Altshuler
Robert M
RM
Post
Gerhard
G
Hellemann
Gabriele S
GS
Leverich
Willem A
WA
Nolen
Mark A
MA
Frye
Paul E
PE
Keck
Ralph W
RW
Kupka
Heinz
H
Grunze
Susan L
SL
McElroy
Catherine A
CA
Sugar
Trisha
T
Suppes
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