By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
Staff Research and Content Writer
© Copyright – SUD RECOVERY CENTERS – A Division of Genesis Behavioral Services, Inc., Milwaukee, Wisconsin – August 2023 – All rights reserved.
A new study could revolutionize the way we treat bipolar disorder.
In a world-first clinical trial, researchers from Canada found that extending the duration of antidepressant treatment from 8 weeks to 52 weeks could help prevent or delay depressive relapses for patients with bipolar disorder. These results challenge current clinical guidelines and could change the way we treat patients with bipolar disorder
What is bipolar disorder?
Bipolar disorder is a mental illness that causes extreme mood swings. Patients cycle through periods of intense emotional highs (mania or hypomania) and lows (depression).
What is the current treatment for depression in patients with bipolar disorder?
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Clinical practice guidelines recommend that patients discontinue using this antidepressant once they have been in remission from their depression for at least eight weeks. However, little is known about how well this treatment works for preventing depressive relapses
What did this study do?
Researchers at the University of British Columbia conducted a randomized clinical trial comparing the standard treatment for depression in patients with bipolar disorder to a an extended duration treatment. The study aimed to understand better the efficacy and safety of treating patients with antidepressants longer than current guidelines recommend.
Patients in this study were recruited from outpatient clinics. They were eligible if they had bipolar disorder, were being treated for depression with either adjunctive escitalopram or adjunctive bupropion XL, and had been in remission from their depression for at least two weeks.
Patients were divided into two treatment groups. The control group received the standard treatment of an adjunct antidepressant, which was discontinued eight weeks post-remission as per clinical guidelines. The treatment group continued to take the antidepressant for 52 weeks after going into remission. The researchers wanted to see how many patients in each group experienced a depressive relapse and the average time it took for the relapse to occur.
What were the results?
The results of this study were mixed. Upon initial analysis, it did not appear that the longer duration of treatment was beneficial in preventing depressive relapse. The relapse rates between the control group (46%) and the treatment group (31%) were not statistically significant, meaning there was no clear benefit to a longer duration of treatment.
However, the researchers conducted another analysis excluding relapse events in the first six weeks of treatment. Patients in both groups received the same treatment during these first six weeks. By excluding these first six weeks, the researchers could more accurately compare the differences in the two treatment durations.
Based on this analysis, patients who continued antidepressant treatment for 52 weeks were 40 percent less likely to experience a relapse of any mood event compared to those treated for eight weeks. They were also 59 percent less likely to experience a depressive episode during the study. Specifically, 31 percent of patients in the control (8-week) group had a depressive episode within the 52-week study period compared to only 17 percent of the treatment (52-week) group.
Dr. Yatham, lead author of the study, summarizes this finding in a news piece for the UBC Faculty of Medicine News:
“From the point where the two groups began receiving different treatments, we see a significant benefit for patients who continued treatment with antidepressants,”
There was no significant difference in the rate of manic episodes or the rate of adverse events between groups. The study found that both durations of adjunct antidepressant treatment were equally safe, and few people discontinued treatment from either group due to adverse side effects. This finding eased the concern that extended antidepressant treatment could induce mania or rapid mood cycling.
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What are the implications of these findings?
This study found that adjunct antidepressant treatment for patients with bipolar disorder is safe and does not lead to serious adverse effects or a worsening of patients’ bipolar disorder.
Lakshmi N. Yatham, Shyam Sundar Arumugham, Muralidharan Kesavan, et al. “Duration of Adjunctive Antidepressant Maintenance in Bipolar I Depression.” New England Journal of Medicine, 2023; 389 (5): 430 DOI: 10.1056/NEJMoa2300184
Modern antidepressants may reduce risk of relapse for patients with bipolar depression. UBC Faculty of Medicine. Published August 3, 2023. Accessed from: https://www.med.ubc.ca/news/modern-antidepressants-may-reduce-risk-of-relapse-for-patients-with-bipolar-depression/
How did this study work?
This study specifically looked at patients with depression who also suffered from insomnia. The researchers were interested in seeing whether electroacupuncture was a safe and effective treatment for patients with comorbid mental health and sleep disorders.
This study was a randomized clinical trial that compared groups of patients receiving the target intervention, electroacupuncture, with sham acupuncture and with standard care (no intervention). Standard care included guidance from a doctor to get regular exercise, eat a healthy diet, and manage their stress levels during the trial, as well as continuing to take any prescribed medications for sleep or depression.
This was the longest study to date to look at acupuncture to treat insomnia. Patients received electroacupuncture three times a week for eight weeks, for a total of 24 sessions. This was followed by a 24-week observational period to see how long the benefits of treatment would last, for a total study duration of 32 weeks.
The acupuncture administered in this study targeted the Governor vessel. According to the researchers, the Governor vessel “governs all yang meridians and helps regulate the balance of yin-yang in the body, which is closely related to brain functions”. Targeting this vessel can help to calm nerves and relax patients, improving their symptoms of depression.
What were the results?
Patients who received electroacupuncture experienced significant improvements to their sleep. Their sleep quality improved, they slept for longer, and they woke up fewer times during the night. These improvements persisted for the duration of the study, meaning that the effects of the acupuncture lasted for weeks after it had been administered.
Electroacupuncture also helped to improve symptoms of mental health disorders. Patients experienced reductions in the severity of insomnia, symptoms of depression, and symptoms of anxiety.
With regard to safety, there were no severe adverse events reported during the trial. The researchers conclude that electroacupuncture may be a safe treatment for patients with comorbid depression and insomnia.
What are the takeaways?
- Electroacupuncture is a safe and effective treatment to help patients with depression-related insomnia improve their quality of sleep.
- The benefits of electroacupuncture on sleep quality continue for over 20 weeks after treatment.
- Electroacupuncture can also help patients improve symptoms of depression and anxiety.
Yin X, Li W, Liang T, et al. Effect of Electroacupuncture on Insomnia in Patients With Depression: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(7):e2220563.