The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression: A retrospective chart review

Background: Current treatment guidelines recommend discontinuation of an an tidepressant within 3 to 6 months after remission of depression in patients with bipolar illness. Yet few studies directly compare the impact of antid epressant discontinuation versus antidepressant continuation on the risk fo r depressive relapse in patients with bipolar disorder who have been succes sfully treated for a depressive episode. Method: In a retrospective chart review, patients with DSM-IV bipolar disor der who were treated for an index episode of depression by adding antidepre ssant medication to ongoing mood stabilizer medications were identified. Th e risk of depressive relapse in 25 subjects who stopped antidepressant medi cations after improvement was compared with the risk of depressive relapse in 19 subjects who continued antidepressants after improvement. Results: Termination of antidepressant medication significantly increased t he risk of a depressive relapse. Antidepressant continuation was not signif icantly associated with an increased risk of mania. Conclusion: While this study may have been limited by the retrospective nat ure of the chart review, nonrandomized assignment of treatment. and relianc e on unstructured progress notes, it suggests that antidepressant discontin uation may increase the risk of depressive relapse in some patients with bi polar disorder. Further research is needed to clarify whether maintenance a ntidepressant treatment may be warranted in some patients with bipolar diso rder, especially in those with frequent recurrent depressive episodes.