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Bouncing back: is the bipolar rebound phenomenon peculiar to lithium? A retrospective naturalistic study

Lookup NU author(s): Mark Franks, Dr Karine Macritchie

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Abstract

In bipolar disorder the discontinuation of lithium prophylaxis is associated with early episode precipitation. Is this 'rebound' phenomenon peculiar to lithium? This naturalistic retrospective case note review investigated the frequency of immediate recurrence after discontinuation of any prophylactic treatment. Bipolar patients who stopped at least one medication after at least 6 months of remission were studied. A total of 310 case notes were examined in a systematic search. A total of 53 cases of discontinuation in 48 subjects were found. Discontinued medications included lithium, valproate, carbamazepine, typical and atypical antipsychotics and antidepressants. Recurrence occurred within 3 months of medication withdrawal in 39 cases (74%). Over half of the discontinuation episodes involved lithium: recurrence occurred in 86% of these cases. In the groups stopping other prophylactic agents, a majority of subjects suffered recurrence: anticonvulsants (89%), antipsychotics (64%) and antidepressants (58%). However, these groups were small and the clarity of the data was undermined by the simultaneous withdrawal of other agents. Manic and hypomanic episodes were the most common form of recurrences. Depressive episodes occurred proportionately most frequently following antidepressant withdrawal. More than half of recurrences required hospital admission. This study provides preliminary naturalistic evidence that early episode recurrence in bipolar disorder is not peculiar to lithium withdrawal but may occur following withdrawal of medication from all classes recommended in prophylaxis. These findings, if replicated, have important implications for clinical practice and for research. © 2008 British Association for Psychopharmacology.

Publication metadata

Author(s): Franks MA, Macritchie KAN, Mahmood T, Young AH

Publication type: Article

Publication status: Published

Journal: Journal of Psychopharmacology

Year: 2008

Volume: 22

Issue: 4

Pages: 452-456

Print publication date: 01/06/2008

ISSN (print): 0269-8811

ISSN (electronic): 1461-7285

Publisher: British Association for Psychopharmacology

URL: http://dx.doi.org/10.1177/0269881107085238

DOI: 10.1177/0269881107085238

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