Results from a naturalistic study show that there is a high risk of relapse among bipolar disorder patients, particularly if their medication is changed or stopped.
More than two-thirds (68%) of the 300 individuals with bipolar I or II disorder, who were evaluated at least once per year via an outpatient clinic, by telephone or with their psychiatrist, relapsed within the 4-year follow-up period, with a mean time to relapse of 208 days, report the researchers.
Relapses, defined as a deterioration or change in state requiring pharmacologic intervention and/or hospitalisation, correlated with changes in medication prescription by the treating physician and the patient stopping their medication. The respective 92 and 48 patients for whom these scenarios occurred relapsed significantly earlier than their counterparts whose medication dose was maintained or increased.
“[W]e propose that psychiatrists act with caution when replacing or stopping drugs and explain to patients that stopping their medication caries a high risk of relapse”, say researcher Benedikt Amann (FIDMAG Research Foundation, Sant Boi de Llobregat, Spain) and colleagues.
A similar proportion of bipolar type I and type II patients relapsed at least once during the study, at 49.5% and 50.5%, respectively, with first affective relapses correlating significantly with the index episode.
Specifically, among patients with a manic or hypomanic first episode, 51.4% relapsed with this same type of episode, while 74.8% of first-episode depressed patients experienced further depression during relapse.
Fewer patients were taking mood-stabilising monotherapy than a combination of prophylactic drugs, at 19.3% versus 80.7%, but only the traditional mineral mood stabiliser alone had a statistically significant preventative effect on relapse, even after controlling for medication cessation.
The researchers remark in the Journal of Clinical Psychiatry that prescription of “modern antidepressants or mood stabilizers does not seem to make a big difference” in the real-world setting.
When assessing time to relapse, patients treated with a traditional mineral mood stabiliser had a longer time to relapse, at a mean of 940 days, compared with their counterparts treated with antipsychotics, at 606 days, anticonvulsants, at 549 days, and combined prophylactic medication, at 598 days.
“[N]ew substances should be tested long-term in bipolar disorder by way of long-term naturalistic studies”, conclude Amann et al, who suggest that results from naturalistic studies as well as randomised controlled trials should be incorporated into recommended treatment guidelines.
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