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Antidepressants Not Safer for Either Bipolar Depression Subtype

Antidepressants Not Safer for Either Bipolar Depression Subtype

One hypothesis about bipolar disorder treatment is that antidepressants may be safer and more effective in patients with type II bipolar disorder than in those with type I bipolar disorder.

These authors studied 21 patients with type I bipolar disorder and 49 patients with type II bipolar disorder who had acute major depressive episodes and were treated with antidepressants plus mood stabilizers to euthymia sustained for 2 months. The patients were then randomized openly to continue or discontinue antidepressants for up to 3 years.

At follow-up after an average of 1.64 years, both subgroups showed improvement in depressive episode frequency with continued use of antidepressants. But more improvement was seen in bipolar disorder-I patients than in bipolar disorder-II patients.

Those with bipolar disorder-II who continued on antidepressants had slightly more depressive episodes, but fewer manic/hypomanic episodes, than those with bipolar disorder-I. There were no differences in time to recurrence of mood episodes or total time in remission.

The authors concluded that long-term antidepressant treatment in patients with bipolar disorder-II does not lead to better outcomes than in patients with bipolar disorder-I, except for a somewhat lower risk of manic/hypomanic episodes.

RESULT: Antidepressants in Type II Versus Type I Bipolar Depression: A Randomized Discontinuation Trial. Journal of Clinical Psychopharmacology. | Oct 1, 2015 (Free abstract. Full Text $53.35)

Although benzodiazepines are often prescribed for bipolar disorder, little is known about which subtypes of bipolar disorder may respond better to benzodiazepine use. These authors examined the prevalence of and factors associated with benzodiazepine use among 482 patients with bipolar I or II disorder; 81 patients were prescribed benzodiazepines.

Bivariate analyses found that benzodiazepine users were prescribed a significantly higher number of other psychotropic medications and were more likely to be prescribed lamotrigine or antidepressants as compared with benzodiazepine nonusers. Also, benzodiazepine users were more likely to have a diagnosis of bipolar I disorder and comorbid anxiety disorder, but not comorbid alcohol or substance use disorders. In addition, benzodiazepine users experienced more anxiety and depressive symptoms and suicidality, but not irritability or manic symptoms.

In a multivariate model, anxiety symptom level, lamotrigine use, number of concomitant psychotropic medications, college education, and high household income predicted benzodiazepine use.

The authors stated that benzodiazepine use in patients with bipolar disorders is associated with greater illness complexity, regardless of a comorbid anxiety disorder diagnosis.

RESULT: Complexity of Illness and Adjunctive Benzodiazepine Use in Outpatients With Bipolar I or II Disorder: Results From the Bipolar CHOICE Study. Journal of Clinical Psychopharmacology. | Feb 1, 2015 (Free abstract. Full Text $53.35)
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