2023-10-15 12:03:41
To remember
A trycarried out in patients suffering from type 1 bipolar disorder and having achieved remission of a recently treated depressive episode, shows that the continuation of antidepressant treatment with escitalopram or bupropion XL for 52 weeks does not provide any benefit in terms of time before relapse compared to treatment continued for only 8 weeks, all mood disorders combined.
Why is this important?
Depressive episodes are common in people suffering from type 1 bipolar disorder and tend to recur. Also, in practice, 80% of patients are prescribed an extension of their antidepressant treatment for at least 6 months after remission of the previous depressive episode. But few studies have evaluated the effectiveness and safety of antidepressants as long-term treatment to limit the recurrence of mood disorders.
Methodology
A Canadian team conducted a multicenter randomized controlled trial in patients with type 1 bipolar disorder in recent remission from a depressive episode. Its objective was to evaluate the effect of continuing treatment with escitalopram (10 to 30 mg/d) or bupropion XL (150 to 450 mg/d), in addition to a mood stabilizer or a second generation antipsychotic or both, compared to stopping antidepressant treatment.
The primary endpoint was the time until the onset of a mood disorder episode: mania or hypomania, depression, suicidal behavior, moderate mood disorder, need for additional treatment or hospitalization for a new episode of mood disorder or for an attempted or successful suicide.
Principle results
In this trial, 209 bipolar type 1 patients received open-label antidepressant treatment. Among the adult subjects who achieved remission of their depressive episode (n=150 + 27 newly admitted), 90 were assigned to a group which continued antidepressant treatment for 52 weeks (52-week group) and 87 were switched to placebo at the 8th week (8 week group). Most trial participants were of Asian origin (87%). The median follow-up duration was 40.5 weeks in the 52-week group and 34 weeks in the 8-week group.
At week 52, 31% of patients in the 52-week group and 46% in the 8-week group had experienced one of the mood disorders included in the primary endpoint. The Hazard Ratio (HR) of the time until the appearance of the first mood disorder (all disorders combined) in the 52-week group vs group 8 week was 0.68 [0,43-1,10] (not significant, p=0.12). It was 2.28 [0,86-6,08] for mania or hypomania and 0.43 [0,25-0,75] for recurrences of depressive episodes.
The incidence of adverse effects appeared similar in both groups, with few treatment discontinuations related to adverse effects.
Principales limitations
Trial recruitment was halted before the planned sample size was reached due to the COVID-19 pandemic and the cessation of funding.
Most participants were recruited from Indian centers.
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