Antidepressants Less Effective for Bipolar
> 5/30/2008 12:14:00 PM


Data published in the New England Journal of Medicine in March 2007 indicated that, for individuals with bipolar disorder who take mood-stabilizing medications, the addition of anti-depressants to the pharmaceutical regimen may not offer any noticeable benefits.

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a 7-year study, completed in 2005 and sponsored by the National Institute of Mental Health, which involved more than 4,000 outpatients diagnosed with BP and addressed multiple forms of treatment and their long-term results. In order to better represent the real-world population to whom it may be applied, the program also included patients with multiple diagnoses who were involved in psycho- and behavioral therapies and various medicinal treatments. All patients involved received at least one form of mood-stabilizer throughout the study, and at no point were any individuals medication-free, but within these parameters patients received whatever treatments their doctors found appropriate. The most significant information drawn from this work reported that there was no substantial difference between patients who took anti-depressants in addition to their base meds and those who took placebos in their place.

The patients were first monitored closely by specialists to determine that their treatments were at maximum efficiency. Then they were randomly assigned to one of two anti-depressants or a sugar-pill placebo. After approximately six months, researchers found that the recurrence of mania was nearly identical in both groups and that the percentage of patients reporting improved conditions for at least eight consecutive weeks was actually slightly higher for those on placebo. They also noted very little difference between the results obtained by the two anti-depressants.

While many associate periods of mania, or uncontrollable emotional peaks with bipolar disorder, deep depressive stretches are actually more common. While anti-depressants have long been prescribed to supplement mood-stabilizers, some psychiatrists have held reservations about giving them to these patients in the fear that they would counteract the pre-existing mood stabilizing medications and provoke further manic episodes. The STEP-BD research determined that, though the medicines are safe to be taken together, they did not, in combination, provide any additional relief from depressive symptoms.

The results illustrated the belief held by some clinicians that carefully managed mood stabilizers serve as sufficient pharmaceutical responses to bipolar disorder. The equation will be expanded by future reports, drawn from the same data, which look to consider the alternate variables of psychotherapy and related treatments.

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