Relapse Prevention in Bipolar II Disorder: The Role of Prozac

Bipolar disorder actually refers to a group of mental health conditions that feature alternating and unpredictable mood states. These conditions are sometimes referred to in terms of the “bipolar spectrum.” Mania, an intensely elevated or euphoric mood, and depression are the mental states typically associated with bipolar disorder. Doctors classify the various subtypes of this disease based upon the severity and occurrence pattern of mania and depression. Bipolar II disorder, for example, entails a higher rate of major depressive episodes, with relatively few instances of mania. Appropriate treatment for all forms of bipolar disorder involves regular cognitive therapy sessions and mood stabilization via pharmaceutical interventions. Doctors may prescribe an indefinite course of psychotropic medications to prevent a patient from lapsing into either depression or mania.

The antidepressant medication Prozac (fluoxetine) is part of a typical treatment plan for those suffering from bipolar II disorder. Prozac works by altering the ratio of certain chemicals within the brain. Rigorous testing has confirmed that this medication is both safe and effective, with relatively minor side effects in most patients. The current guidelines for bipolar II treatment recommend discontinuing Prozac within several weeks of depression remission, because clinicians suspect that prolonged antidepressant therapy may trigger a manic state. The mood stabilizer lithium is therefore preferred for long-term maintenance therapy. A team of clinical investigators set out to challenge the notion of Prozac’s danger, testing Prozac against lithium in a double-blind, placebo-controlled study in a group of individuals with bipolar II disorder.

All participants in the study had recently recovered from a depressive episode with the assistance of Prozac. One group was switched to lithium, one to placebo, and one continued on Prozac. Participants were blind to their treatment condition, and the study moved forward for 50 weeks. Psychiatric interviews and patient self-reporting helped pinpoint relapse events and overall mental health status. The results of the study were surprising even to the researchers. Those taking lithium were 2.5 times more likely to relapse than those taking Prozac. Similarly, the time to relapse, when it did occur, was far longer with Prozac than lithium. Most importantly, episodes of mania in the Prozac group were not significantly greater than either the placebo or lithium group.

Conventional wisdom argues against maintenance treatment with antidepressants for bipolar individuals. However, recent study results have challenged that wisdom, at least in the case of bipolar II disorder. For those suffering from this variety of the disease, long-term treatment with Prozac appears to be safe and effective for both preventing relapse and staving off manic episodes.

References

1. Amsterdam, J.D. & Shults, J. (2010). Efficacy and safety of long-term fluoxetine versus lithium monotherapy of bipolar II disorder: a randomized, double-blind, placebo-substitution study. American Journal of Psychiatry, 167, (7), 792-800.
2. Fluoxetine – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved April 11, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/

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