Escitalopram in Bipolar Disorder Management amongst Adults in Saudi Arabia: A Cross-sectional Study
Authors: Alawad Fatema Hani , Ali Raghad , Alawaji Mayadah , Alessa Abdullah , Alkhammash Abeer , AlKhammash Taif , Qurairees Walaa Abdullah Ali , Alhodibi Mostafa Habeeb 
Published: December 2024

Abstract

Introduction:
Bipolar disorder (BD) is a significant psychiatric condition affecting over 1% of the global population, characterised by episodes of depression and mania or hypomania. The disorder poses substantial mental health challenges, including increased mortality and suicide risk. Conventionally, treatment has focussed on the manic phase, but recent studies emphasise the importance of managing the depressive phase due to its associated morbidity and functional impairment. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like escitalopram, have emerged as potential treatments for bipolar depression, though their safety, especially regarding the risk of inducing mania or hypomania, remains a concern. This study aims to assess the effectiveness and safety of escitalopram in reducing depressive symptoms amongst individuals with BD in Saudi Arabia, offering insights into its role in BD therapy.

Methods:
This cross-sectional study, conducted from January to September 2023, targeted adults aged 18 years and older with a clinical diagnosis of BD in Saudi Arabia. Participants completed a comprehensive questionnaire in Arabic and English, covering sociodemographic data, clinical characteristics, medication history and validated assessment scales for depressive symptoms and manic or hypomanic episodes. The study design sought to capture a broad snapshot of escitalopram’s effects and included a detailed analysis of symptom reduction and overall mental health improvement. Ethical approval was obtained from the Deanship of Scientific Research at King Faisal University.

Results:
The study included 1682 participants, predominantly male and with a Bachelor’s degree, from urban areas in the Eastern Province of Saudi Arabia. A significant proportion of participants reported using escitalopram for BD management. Key findings include that 55.2% of participants using escitalopram reported a significant improvement in depressive symptoms, and 53.4% observed a decrease in the frequency of depressive episodes. In addition, a majority reported no increase in the frequency of manic or hypomanic episodes since starting escitalopram, with many expressing high satisfaction with its effectiveness in managing these episodes. However, the impact on the need for additional medications was not significantly associated with escitalopram usage.

Conclusion:
This study demonstrates that escitalopram significantly reduces the frequency of depressive episodes in individuals with BD in Saudi Arabia, aligning with existing research and contributing new insights specific to this population. While indicating escitalopram as a viable treatment option, the study highlights the need for cautious monitoring of its effects on manic episodes. The findings suggest a potential re-evaluation of clinical protocols and public health strategies in managing BD, emphasising the importance of personalised treatment approaches and ongoing monitoring. This research enriches the understanding of antidepressant use in BD, serving as a foundation for future investigations and potential shifts in treatment strategies.