Antidepressant therapy did not provide increased benefit, versus a placebo, for patients with bipolar disorder already treated with mood stabilizers, according to a study of 366 participants conducted by nearly a dozen institutions nationwide, including The University of Texas Health Science Center at San Antonio.
Patients with bipolar disorder suffer wide swings in mood between mania and depression, and the depressive episodes are the most frequent cause of disability for them. The researchers evaluated how many patients in the antidepressant group and the placebo group made a “durable recovery,” defined as eight consecutive weeks of moderated mood (not manic or depressed).
Charles L. Bowden, M.D., professor who holds the Nancy Ullman Karren Chair in Psychiatry at The University of Texas Health Science Center at San Antonio, was a study co-author. The results were published this week online by The New England Journal of Medicine.
During the study,179 subjects received a mood stabilizer plus adjunct antidepressant therapy; 42 (23.5 percent) of these individuals had a durable recovery. Another 187 participants received a mood stabilizer and placebo; 51 of them (27.3 percent) had a durable recovery.
Not many studies have examined the effectiveness and safety of adjunct antidepressant therapy for depressive episodes associated with bipolar disorder. The authors noted that “longer-term outcome studies are needed to fully assess the benefits and risks of antidepressant therapy for bipolar disorder.”
“This is a landmark study, because it shows that traditional antidepressants don’t work in bipolar disorder,” said Pedro L. Delgado, M.D., the Dielmann Professor and chairman of the department of psychiatry at the Health Science Center. “Dr. Bowden has been one of the world’s leaders in use of mood stabilizers for the treatment of bipolar disorder, and this work reinforces the fact that treatment of depression in people with bipolar disorder must rely more on mood stabilizers instead of traditional antidepressants.”
Mood stabilizers include lithium and valproic acid (Depakote). Antidepressants include fluoxetine (Prozac) and imipramine. Dr. Bowden led research on the major study that resulted in approval of Depakote for treatment of bipolar disorder.
“We are very pleased and proud to have one of the world’s leading experts on treatment of this disorder in our institution,” Dr. Delgado said.
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