Long-term fluoxetine therapy for bipolar disorder type II

January 01, 0001

Long-term fluoxetine therapy for bipolar disorder type II

These US authors conducted a randomized trial to examine the safety and efficacy of long-term fluoxetine monotherapy, lithium monotherapy, and placebo therapy for prevention of relapse and recurrence of bipolar type II major depressive episode. They included patients at least 18 years old who recovered from their major depressive episode during initial open-label fluoxetine monotherapy. Patients were randomly assigned to receive 50 weeks of double-blind monotherapy with fluoxetine at 10-40 mg/day, lithium at 300-1200 mg/day, or placebo.

They found: "There were no significant differences in clinical or demographic characteristics among the fluoxetine (N=28), lithium (N=26), and placebo (N=27) groups. The mean time to relapse was 249.9 days for the fluoxetine group, 156.4 days for the lithium group, and 186.9 days for the placebo group. The hazard of relapse was significantly lower with fluoxetine compared with lithium, and the estimated hazard of relapse with lithium was 2.5 times greater than with fluoxetine. There were no statistically significant or clinically meaningful differences in hypomanic symptoms among treatment groups over time. One patient taking fluoxetine and one patient taking placebo discontinued treatment because of hypomania."

The authors concluded: "These findings suggest that long-term fluoxetine monotherapy may provide superior relapse-prevention benefit relative to lithium monotherapy after recovery from bipolar II major depressive episode without an increase in hypomanic mood conversion episodes."

A larger study would be needed to draw conclusions about the effects on hypomania.

For the full abstract, click here.

Am J Psychiatry 167:792-800, July 2010
© 2010 to the American Psychiatric Association
Efficacy and Safety of Long-Term Fluoxetine Versus Lithium Monotherapy of Bipolar II Disorder: A Randomized, Double-Blind, Placebo- Substitution Study. Jay D. Amsterdam, and Justine Shults. Correspondence to Dr. Amsterdam: [email protected]

Category: P. Psychological. Keywords: bipolar disorder type II, depression, fluoxetine, lithium, hypomania, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 13 August 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.