The Impact of Antidepressant Discontinuation Versus Antidepressant Continuation on 1-Year Risk for Relapse of Bipolar Depression: A Retrospective Chart Review
J Clin Psychiatry 2001;62:612-616
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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
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
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.