The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression

A retrospective chart review

L. Altshuler, L. Kiriakos, J. Calcagno, R. Goodman, M. Gitlin, Mark A Frye, J. Mintz

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

Background: Current treatment guidelines recommend discontinuation of an antidepressant within 3 to 6 months after remission of depression in patients with bipolar illness. Yet few studies directly compare the impact of antidepressant discontinuation versus antidepressant continuation on the risk for depressive relapse in patients with bipolar disorder who have been successfully treated for a depressive episode. Method: In a retrospective chart review, patients with DSM-IV bipolar disorder who were treated for an index episode of depression by adding antidepressant medication to ongoing mood stabilizer medications were identified. The risk of depressive relapse in 25 subjects who stopped antidepressant medications after improvement was compared with the risk of depressive relapse in 19 subjects who continued antidepressants after improvement. Results: Termination of antidepressant medication significantly increased the risk of a depressive relapse. Antidepressant continuation was not significantly associated with an increased risk of mania. Conclusion: While this study may have been limited by the retrospective nature of the chart review, nonrandomized assignment of treatment, and reliance on unstructured progress notes, it suggests that antidepressant discontinuation may increase the risk of depressive relapse in some patients with bipolar disorder. Further research is needed to clarify whether maintenance antidepressant treatment may be warranted in some patients with bipolar disorder, especially in those with frequent recurrent depressive episodes.

Original languageEnglish (US)
Pages (from-to)612-616
Number of pages5
JournalJournal of Clinical Psychiatry
Volume62
Issue number8
StatePublished - 2001
Externally publishedYes

Fingerprint

Bipolar Disorder
Antidepressive Agents
Recurrence
Depression
Diagnostic and Statistical Manual of Mental Disorders
Therapeutics
Maintenance
Guidelines

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression : A retrospective chart review. / Altshuler, L.; Kiriakos, L.; Calcagno, J.; Goodman, R.; Gitlin, M.; Frye, Mark A; Mintz, J.

In: Journal of Clinical Psychiatry, Vol. 62, No. 8, 2001, p. 612-616.

Research output: Contribution to journalArticle

@article{3a1d2404c57047f1a7d49c0137779671,
title = "The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression: A retrospective chart review",
abstract = "Background: Current treatment guidelines recommend discontinuation of an antidepressant within 3 to 6 months after remission of depression in patients with bipolar illness. Yet few studies directly compare the impact of antidepressant discontinuation versus antidepressant continuation on the risk for depressive relapse in patients with bipolar disorder who have been successfully treated for a depressive episode. Method: In a retrospective chart review, patients with DSM-IV bipolar disorder who were treated for an index episode of depression by adding antidepressant medication to ongoing mood stabilizer medications were identified. The risk of depressive relapse in 25 subjects who stopped antidepressant medications after improvement was compared with the risk of depressive relapse in 19 subjects who continued antidepressants after improvement. Results: Termination of antidepressant medication significantly increased the risk of a depressive relapse. Antidepressant continuation was not significantly associated with an increased risk of mania. Conclusion: While this study may have been limited by the retrospective nature of the chart review, nonrandomized assignment of treatment, and reliance on unstructured progress notes, it suggests that antidepressant discontinuation may increase the risk of depressive relapse in some patients with bipolar disorder. Further research is needed to clarify whether maintenance antidepressant treatment may be warranted in some patients with bipolar disorder, especially in those with frequent recurrent depressive episodes.",
author = "L. Altshuler and L. Kiriakos and J. Calcagno and R. Goodman and M. Gitlin and Frye, {Mark A} and J. Mintz",
year = "2001",
language = "English (US)",
volume = "62",
pages = "612--616",
journal = "Journal of Clinical Psychiatry",
issn = "0160-6689",
publisher = "Physicians Postgraduate Press Inc.",
number = "8",

}

TY - JOUR

T1 - The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression

T2 - A retrospective chart review

AU - Altshuler, L.

AU - Kiriakos, L.

AU - Calcagno, J.

AU - Goodman, R.

AU - Gitlin, M.

AU - Frye, Mark A

AU - Mintz, J.

PY - 2001

Y1 - 2001

N2 - Background: Current treatment guidelines recommend discontinuation of an antidepressant within 3 to 6 months after remission of depression in patients with bipolar illness. Yet few studies directly compare the impact of antidepressant discontinuation versus antidepressant continuation on the risk for depressive relapse in patients with bipolar disorder who have been successfully treated for a depressive episode. Method: In a retrospective chart review, patients with DSM-IV bipolar disorder who were treated for an index episode of depression by adding antidepressant medication to ongoing mood stabilizer medications were identified. The risk of depressive relapse in 25 subjects who stopped antidepressant medications after improvement was compared with the risk of depressive relapse in 19 subjects who continued antidepressants after improvement. Results: Termination of antidepressant medication significantly increased the risk of a depressive relapse. Antidepressant continuation was not significantly associated with an increased risk of mania. Conclusion: While this study may have been limited by the retrospective nature of the chart review, nonrandomized assignment of treatment, and reliance on unstructured progress notes, it suggests that antidepressant discontinuation may increase the risk of depressive relapse in some patients with bipolar disorder. Further research is needed to clarify whether maintenance antidepressant treatment may be warranted in some patients with bipolar disorder, especially in those with frequent recurrent depressive episodes.

AB - Background: Current treatment guidelines recommend discontinuation of an antidepressant within 3 to 6 months after remission of depression in patients with bipolar illness. Yet few studies directly compare the impact of antidepressant discontinuation versus antidepressant continuation on the risk for depressive relapse in patients with bipolar disorder who have been successfully treated for a depressive episode. Method: In a retrospective chart review, patients with DSM-IV bipolar disorder who were treated for an index episode of depression by adding antidepressant medication to ongoing mood stabilizer medications were identified. The risk of depressive relapse in 25 subjects who stopped antidepressant medications after improvement was compared with the risk of depressive relapse in 19 subjects who continued antidepressants after improvement. Results: Termination of antidepressant medication significantly increased the risk of a depressive relapse. Antidepressant continuation was not significantly associated with an increased risk of mania. Conclusion: While this study may have been limited by the retrospective nature of the chart review, nonrandomized assignment of treatment, and reliance on unstructured progress notes, it suggests that antidepressant discontinuation may increase the risk of depressive relapse in some patients with bipolar disorder. Further research is needed to clarify whether maintenance antidepressant treatment may be warranted in some patients with bipolar disorder, especially in those with frequent recurrent depressive episodes.

UR - http://www.scopus.com/inward/record.url?scp=0034855257&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034855257&partnerID=8YFLogxK

M3 - Article

VL - 62

SP - 612

EP - 616

JO - Journal of Clinical Psychiatry

JF - Journal of Clinical Psychiatry

SN - 0160-6689

IS - 8

ER -