Impact of antidepressant continuation after acute positive or partial treatment response for bipolar depression: A blinded, randomized study

Lori L. Altshuler, Robert M. Post, Gerhard Hellemann, Gabriele S. Leverich, Willem A. Nolen, Mark A Frye, Paul E. Keck, Ralph W. Kupka, Heinz Grunze, Susan L. McElroy, Catherine A. Sugar, Trisha Suppes

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Abstract

Objective: To assess long-term outcome in bipolar disorder, subjects were prospectively followed after receiving acute treatment for bipolar depression. Method: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)450-457
Number of pages8
JournalJournal of Clinical Psychiatry
Volume70
Issue number4
DOIs
StatePublished - Apr 2009

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Bipolar Disorder
Antidepressive Agents
Therapeutics
Equipment and Supplies
Diagnostic and Statistical Manual of Mental Disorders
Outpatients

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Impact of antidepressant continuation after acute positive or partial treatment response for bipolar depression : A blinded, randomized study. / Altshuler, Lori L.; Post, Robert M.; Hellemann, Gerhard; Leverich, Gabriele S.; Nolen, Willem A.; Frye, Mark A; Keck, Paul E.; Kupka, Ralph W.; Grunze, Heinz; McElroy, Susan L.; Sugar, Catherine A.; Suppes, Trisha.

In: Journal of Clinical Psychiatry, Vol. 70, No. 4, 04.2009, p. 450-457.

Research output: Contribution to journalArticle

Altshuler, LL, Post, RM, Hellemann, G, Leverich, GS, Nolen, WA, Frye, MA, Keck, PE, Kupka, RW, Grunze, H, McElroy, SL, Sugar, CA & Suppes, T 2009, 'Impact of antidepressant continuation after acute positive or partial treatment response for bipolar depression: A blinded, randomized study', Journal of Clinical Psychiatry, vol. 70, no. 4, pp. 450-457. https://doi.org/10.4088/JCP.08m04191
Altshuler, Lori L. ; Post, Robert M. ; Hellemann, Gerhard ; Leverich, Gabriele S. ; Nolen, Willem A. ; Frye, Mark A ; Keck, Paul E. ; Kupka, Ralph W. ; Grunze, Heinz ; McElroy, Susan L. ; Sugar, Catherine A. ; Suppes, Trisha. / Impact of antidepressant continuation after acute positive or partial treatment response for bipolar depression : A blinded, randomized study. In: Journal of Clinical Psychiatry. 2009 ; Vol. 70, No. 4. pp. 450-457.
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abstract = "Objective: To assess long-term outcome in bipolar disorder, subjects were prospectively followed after receiving acute treatment for bipolar depression. Method: 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. Conclusion: 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.",
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AU - Altshuler, Lori L.

AU - Post, Robert M.

AU - Hellemann, Gerhard

AU - Leverich, Gabriele S.

AU - Nolen, Willem A.

AU - Frye, Mark A

AU - Keck, Paul E.

AU - Kupka, Ralph W.

AU - Grunze, Heinz

AU - McElroy, Susan L.

AU - Sugar, Catherine A.

AU - Suppes, Trisha

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N2 - Objective: To assess long-term outcome in bipolar disorder, subjects were prospectively followed after receiving acute treatment for bipolar depression. Method: 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. Conclusion: 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.

AB - Objective: To assess long-term outcome in bipolar disorder, subjects were prospectively followed after receiving acute treatment for bipolar depression. Method: 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. Conclusion: 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.

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