Use of antidepressants in maintenance phase of patients with bipolar disorder in an outpatient setting

Abstract

IntroductionGuidelines for the maintenance treatment of bipolar disorder discourage the use of antidepressants chiefly on grounds of unproven efficacy and risk if mania for bipolar I. However, for patients stabilised on an antidepressant, naturalistic data support its continued use.AimThe aim is to describe use of antidepressants in patients with bipolar disorder in remission seen at an outpatient clinic in Singapore.MethodsThe case notes of patients with bipolar disorder in remission, seen by psychiatrist in an outpatient psychiatric clinic in a general hospital unit from December 2014 to March 2015 were studied. Data describing the age, sex, type of bipolar disorder and psychotropic medications prescribed, was obtained.ResultsForty-two patients were included, of which 13 (31%) were male and 29 (69%) were female. The age ranged from 23 to 82, with mean age of 47 years. Of these 17 (40%) had bipolar I and 25 (60%) had bipolar II. Antidepressant use for maintenance treatment was present in 19 out of 42 (45%) of these patients; of these 7 out of 17 (41%) were bipolar 1 and 12 out of 25 (48%) were bipolar II. Eighteen out of the 19 (95%) patients who were prescribed antidepressants were on combination treatment with mood stabilizers. Antidepressant type included SSRI (37%), NDRI (37%), SNRI (10.5%), TCA (10.5%), NASSA (5%).ConclusionAlmost half of patients with bipolar disorder managed in an individual practice were on antidepressants together with mood stabilisers. They remained in remission with combination treatment, which did not seem to jeopardise their condition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A systematic review and meta‐analysis of delayed help‐seeking, delayed diagnosis and duration of untreated illness in bipolar disorders

“…Taking all the above findings together, it is possible to build a narrative about pathways to diagnosis and treatment reported by clinical and community surveys of patients and their advocates. For example, they typically suggest that the median age at initiation of BD‐specific treatments is about 30 years, no matter what the AAO of BD 8,10,93 . Those finding are now supported by our analyses of pooled data that show that AAO was inversely associated with DUB (see Table 2B).…”

“…The studies evaluated the latency between the age at onset (AAO) and age at diagnosis of BD and/or between the onset of BD and initiation of guideline recommended BD‐specific treatment (i.e., a mood stabilizer). However, findings were often reported in terms of the proportion of survey responders who experienced prolonged latencies 4–10 . For example, a survey of the members of a patient advocacy organization estimated that about 30% of individuals with a self‐reported diagnosis of BD experienced a 10‐year delay between the onset of symptoms and receipt of BD‐specific treatments 5 .…”

“…For example, a survey of the members of a patient advocacy organization estimated that about 30% of individuals with a self‐reported diagnosis of BD experienced a 10‐year delay between the onset of symptoms and receipt of BD‐specific treatments 5 . Also, many of the early studies were small scale, and/or failed to provide definitions of the latency constructs, and/or reported wide‐ranging estimates of delays that were difficult to interpret 6–10 . Overall, the research was undermined by the lack of agreement about how to best translate the DUI/DUP concepts into reliable and valid markers of the early course of BD 11,12 .…”

“…5 Also, many of the early studies were small scale, and/or failed to provide definitions of the latency constructs, and/or reported wide-ranging estimates of delays that were difficult to interpret. [6][7][8][9][10] Overall, the research was undermined by the lack of agreement about how to best translate the DUI/DUP concepts into reliable and valid markers of the early course of BD. 11,12 Indeed, a previous scoping review identified 16 different definitions of the time interval between the onset of symptoms or episodes of BD and help-seeking and/or diagnosis and/or treatment were used (in just over 20 studies).…”

“…However, findings were often reported in terms of the proportion of survey responders who experienced prolonged latencies. [4][5][6][7][8][9][10] For example, a survey of the members of a patient advocacy organization estimated that about 30% of individuals with a selfreported diagnosis of BD experienced a 10-year delay between the onset of symptoms and receipt of BD-specific treatments. 5 Also, many of the early studies were small scale, and/or failed to provide definitions of the latency constructs, and/or reported wide-ranging estimates of delays that were difficult to interpret.…”