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Duration of Adjunctive Antidepressant Maintenance in Bipolar I Depression.
N Engl J Med
August 2023
From the Vancouver Hospital Department of Psychiatry (L.N.Y., G.S., R.W.L.) and the School of Population and Public Health (Y.O., H.W.), University of British Columbia, Vancouver, the Department of Psychiatry, University of Ottawa, Ottawa (G.S.), the Department of Psychiatry, Sunnybrook Health Sciences Centre (A.S.), and the Centre for Addiction and Mental Health (A.R., N.R.), University of Toronto, Toronto, St. Joseph's Healthcare, the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON (B.N.F.), Douglas Hospital, McGill University (A.D., S.B.), and Hôpital Sacré-Coeur, Université de Montréal (A.D.), Montreal, and the Department of Psychiatry, Queen's University, Providence Care, Kingston, ON (R.M.) - all in Canada; the National Institute of Mental Health and Neuro Sciences (S.S.A., M.K., K.R., N.S.M., N.K., Y.C.J.R.) and St. John's Hospital Research Institute (M.V.A.), Bangalore, ASHA Hospital, Hyderabad (M.S.R.), and Kasturba Medical College of Manipal, Manipal Academy of Higher Education, Manipal (R.P.B.) - all in India; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (D.J.B.); and Seoul National University Bundang Hospital, Seongnam (K.H.), and Seoul National University Hospital (SNUH), Seoul (Y.M.A.) - both in South Korea.
Background: Antidepressants are used to treat acute depression in patients with bipolar I disorder, but their effect as maintenance treatment after the remission of depression has not been well studied.
Methods: We conducted a multisite, double-blind, randomized, placebo-controlled trial of maintenance of treatment with adjunctive escitalopram or bupropion XL as compared with discontinuation of antidepressant therapy in patients with bipolar I disorder who had recently had remission of a depressive episode. Patients were randomly assigned in a 1:1 ratio to continue treatment with antidepressants for 52 weeks after remission or to switch to placebo at 8 weeks.