The following is a summary of “Duration of Adjunctive Antidepressant Maintenance in Bipolar I Depression,” published in the August 2023 issue of Psychiatry by Yatham et al.

Researchers performed a retrospective study to investigate the efficacy and safety of antidepressants as maintenance treatment after the remission of depression in patients with bipolar I disorder.

They initiated a multicenter, double-blind, randomized, placebo-controlled trial to explore the extension of adjunctive escitalopram or bupropion XL treatment against the cessation of antidepressant therapy in individuals with bipolar I disorder who had recently re-emission from a depressive episode. Patients were evenly split: one group sustained antidepressants for 52 weeks post-remission, and the other shifted to placebo after 8 weeks. Through time-to-event analysis, the main metric covered mood episodes identified by scale scores for hypomanic or manic symptoms, depression, suicidality, and mood episode severity. Also considered were extra treatments, mood-related hospitalizations, and suicide efforts or completions. Secondary results notably assessed the duration between mania, hypomania, or depression episodes.

 The results showed 209 bipolar I disorder patients,150 in depression remission, 27 directly enrolled, 90 got 52 weeks (group) of antidepressants, 87 switched to placebo at 8 weeks(group). The trial was halted early due to recruitment issues. At 52 weeks, 28 in a 52-week (31%) and 40 in an 8-week group (46%) had primary-outcome events. The hazard ratio for 52-week vs. 8-week groups’ time to any mood episode: 0.68 (95% CI 0.43 to 1.10; P=0.12). In 52-week, 11 (12%) had mania/hypomania vs. 5 (6%) in 8-week (hazard ratio, 2.28; 95% CI 0.86 to 6.08); depression recurrence: 15 (17%) vs. 35 (40%) (hazard ratio, 0.43; 95% CI 0.25 to 0.75). Adverse events were similar between groups.

They concluded adjunctive treatment with escitalopram or bupropion XL for 52 weeks did not significantly benefit over 8 weeks in preventing relapse of any mood episode in patients with bipolar I disorder.

Source: nejm.org/doi/full/10.1056/NEJMoa2300184