Tel Aviv University research shows that antidepressants can prevent rehospitalization among bipolar patients

Giving antidepressants to patients suffering from bipolar disorder – which involves chronic high and low mood swings – has been shown to lower the incidence of rehospitalization when they are re-experience the “lows,” according to new Tel Aviv University research.

Bipolar disorder patients, who comprise 1% to 4% of the population, show at different times bursts of excess energy and a rise in self-esteem, or a drop in self-esteem and depression that can result in suicidal thoughts or behavior.

“This study provides hope for bipolar disorder patients by supporting the efficacy and safety of antidepressant therapy use for bipolar depression, which has always been considered a ‘treatment-resistant’ disabling state,” wrote research leader Dr. Eldar Hochman of TAU’s Sackler Faculty of Medicine and Geha Mental Health Center. The study was recently published in the journal European Neuropsychopharmacology.

“Our study suggests that adding antidepressant therapy to mood stabilizers or atypical antipsychotics after hospitalization for bipolar depression can prevent rehospitalization in the shortand long-term. Adding the antidepressant therapy doesn’t increase the risk of manic episodes,” Hochman stated. “Our results are immediately relevant to clinical practice and should encourage clinicians to prescribe antidepressant therapy to bipolar disorder depression in patients with adequate mood stabilization.”

Antidepressants are widely used to manage bipolar depression, but there has been little evidence to support their effectiveness until now. “Our study supports a positive risk-benefit ratio for the use of antidepressants in treating the depression of ‘real-world’ bipolar disorder patients,” said Hochman.

In the study, 98 patients with bipolar disorder who had been hospitalized with a depressive episode at Geha Mental Health Center in Petah Tikva between 2005 and 2013, were retrospectively evaluated for rehospitalization rates at sixmonth and one-year intervals..

“We used a retrospective chart review to compare six-month and one-year rehospitalization rates of bipolar disorder patients hospitalized with a depressive episode. They were treated at discharge with mood stabilizers and/ or atypical antipsychotics with or without antidepressants,” noted Hochman. “We wanted to track their treatment at discharge – with or without antidepressants – and used multi-variable survival models adjusted for variations known to influence rehospitalization.”

The research found that within one year following discharge, 81.7% of the patients who were treated with antidepressants and mood stabilizers avoided rehospitalization, compared to 57.6% of the patients who did not undergo the same combination.

“Antidepressant treatment pursued alone, without an additional mood stabilizing therapy, should be avoided in bipolar depression due to an increased risk for manic episodes,” Hochman advised.

The researchers are currently studying the sociodemographic and clinical prognostic factors affecting outcomes among patients with bipolar disorder. “We hope that our data will help to develop a disease-staging system to allow individuals to reclaim control of their lives,” she concluded.