From the Guidelines
The risk of relapse in bipolar disorder is high, with more than 80% of patients experiencing at least one episode of relapse, and therefore, ongoing medication therapy is often required to prevent relapse 1.
Risk of Relapse
The risk of relapse in bipolar disorder is a significant concern, with studies showing that more than 80% of patients will experience at least one episode of relapse 1. This highlights the importance of ongoing medication therapy to prevent relapse.
- The American Psychiatric Association (1994) found that withdrawal of maintenance lithium therapy is associated with an increased risk of relapse, especially within the 6-month period following lithium discontinuation 1.
- A study by Strober et al. (1990) found that more than 90% of adolescents with bipolar disorder who were noncompliant with their lithium treatment relapsed, compared to 37.5% of those who were compliant with treatment 1.
- Findling et al. (2003) found that the majority of subjects with bipolar disorder relapsed after switching to monotherapy, with no difference in relapse rates between lithium and valproate 1.
Maintenance Therapy
Maintenance therapy is often necessary for individuals with bipolar disorder, with some requiring lifelong therapy when the benefits of continued treatment outweigh the risks 1.
- The regimen needed to stabilize acute mania should be maintained for 12 to 24 months, and any attempts to discontinue prophylactic therapy should be done gradually, while closely monitoring the patient for relapse 1.
- Patients and families must be thoroughly educated on the early signs and symptoms of mood episodes, so that resumption of therapy can be initiated if necessary 1.
Recent Evidence
More recent evidence from a 2020 study on autoimmune hepatitis found that relapse occurs in 50%-87% of adults and 60%-80% of children after drug withdrawal 1.
- The study found that the principal predisposing factors for relapse are the duration and completeness of inactive disease prior to treatment withdrawal, and that patients who relapse almost invariably respond to retreatment with the original regimen 1.
- However, this evidence may not be directly applicable to bipolar disorder, and therefore, the 2007 study by the American Academy of Child and Adolescent Psychiatry remains the most relevant guidance for managing bipolar disorder 1.
From the FDA Drug Label
In the patient being treated for opiate dependence with methadone maintenance therapy, these risks include a very high likelihood of relapse to illicit drug use following methadone discontinuation Patients seeking to discontinue treatment should be apprised of the high risk of relapse to illicit drug use associated with discontinuation of methadone maintenance treatment
The risk of relapse is very high in patients who discontinue methadone maintenance therapy 2, 2.
From the Research
Risk of Relapse
The risk of relapse in individuals with substance use disorders is a significant concern, with various factors contributing to the likelihood of relapse. Some of the key factors associated with an increased risk of relapse include:
- Early age of onset 3
- Dysfunction in the brain reward system 3
- Poor physical health 3
- Sleep disturbance 3
- Comorbid psychiatric disorders 3, 4, 5
- Severity of substance use disorder 3
- Craving 3
- Low self-efficacy 3
- Negative life events 3
- Low socioeconomic status 3
- Family history of substance use disorder 4, 5
- Use of major opioids, especially in the presence of a coexisting psychiatric disorder 4
- Cannabis use disorder 5
Predictors of Relapse
Several studies have identified predictors of relapse in individuals with substance use disorders. These include:
- Motivation to quit substance use 6
- Risk of depression 6
- Being on probation 6
- Being employed 6
- Substance use intensity 6
- Intrinsic motivation 5
- Age, with older individuals being less likely to relapse 5
- Gender, with females being less likely to relapse 5
Effective Interventions
Various interventions have been shown to be effective in reducing the risk of relapse, including:
- Pharmaceutical agents such as methadone, buprenorphine, and naltrexone for opioid and alcohol use disorders 3
- Psychotherapeutic approaches, including motivational interviewing, cognitive behavioral therapy, 12-step programs, and contingency management 3, 7
- Mindfulness-based relapse prevention (MBRP) 7
- Standard relapse prevention 7
- Treatment as usual, including 12-step programming and psychoeducation 7