Although current guidelines suggest discontinuation of antidepressants 6 months after the symptoms of acute bipolar depression ease, the relapse rate is cut by almost one half when antidepressants are continued for 1 year, according to an article in the July issue of the American Journal of Psychiatry. Patients who took antidepressants plus mood stabilizer medication for 1 year had no increase in incidence of manic relapse.

"The common clinical practice of discontinuing antidepressant use in bipolar patients soon after remission of depression symptoms may actually increase the risk of relapse," said Lori Altshuler, MD, the study's lead author.

"Long-held concerns regarding a risk of switching into mania may actually interfere with establishing effective guidelines for treating and preventing relapse of bipolar depression," she said. "Guidelines more similar to those of maintenance treatment of unipolar depression may be more appropriate for individuals with bipolar depression who respond well to antidepressants. A controlled, randomized study is needed to address these questions."

In the current study, researchers examined 84 people with bipolar disorder whose depression symptoms eased with the addition of an antidepressant agent to an ongoing mood stabilizer. Researchers compared the risk of depression relapse in 43 individuals who discontinued antidepressants within 6 months of remission with the risk of relapse in 41 who continued taking antidepressants.

At 1 year after improvement of depression symptoms, 70 percent of the shorter-term antidepressant group had relapsed compared with 36 percent of the longer-term group.