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Acute treatments for bipolar II depression have similar outcomes

Mood switch and treatment response rates were comparable among three acute treatments for bipolar II depression; however, dropout rates were higher for combination therapy with lithium and sertraline.

“Treatment recommendations vary for bipolar II depression, but concerns remain that antidepressant use as monotherapy or in combination with a mood stabilizer could increase the risk for switch to hypomania or cause cycle acceleration. Clinicians, however, routinely use antidepressants as part of their treatment regimen for bipolar disorder,” Lori L. Altshuler, MD, of the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues wrote.

To compare risk for medication-induced mood switch, treatment response and adverse effects of three acute-phase treatments for bipolar II depression, researchers conducted a 16-week, double-blind, multisite comparison study among 142 individuals with bipolar II depression. Study participants were randomly assigned to receive lithium monotherapy (n = 49), sertraline monotherapy (n = 45) or combination treatment with lithium and sertraline (n = 48). Mood was assessed at each visit.

Fourteen percent of the cohort experienced a switch, including hypomania (n = 17) and severe hypomania (n = 3).

Switch rates did not differ between treatment groups. This remained true after accounting for dropout.

There were no manic switches and no participants were hospitalized for a switch.

Most switches occurred during the first 5 weeks of treatment, according to the researchers.

Overall treatment response rate was 62.7%. Response rates did not significantly differ between treatment groups after accounting for dropout.

Dropout rates were significantly higher among participants who received combination treatment, despite not having a quicker response time.

“Our results suggest that lithium monotherapy, sertraline monotherapy, and lithium/sertraline combination therapy are associated with equivalent switch rates and that monotherapy is associated with less treatment discontinuation than combination therapy,” the researchers wrote. “Response rates were similar across treatment groups among those with a rapid cycling course, while for non–rapid cyclers, response rates were superior in the monotherapy groups compared with the combination therapy group. Combination therapy did not accelerate response relative to the monotherapy groups.” – by Amanda Oldt

Disclosure: Altshuler reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.