title: Treatment of depressed bipolar patients with alcohol use disorders: plenty of room for improvement.
abstract: BACKGROUND
  We aimed to examine the adequacy of antidepressant treatment and compliance with treatment in bipolar patients with and without alcohol use disorders (AUD). We hypothesize that the adequacy of antidepressant treatment and the compliance with treatment for those with AUD are lower than for those without AUD.
  
  
  METHODS
  Subjects were 97 patients with current bipolar major depressive episode, 39 (40.2%) with lifetime history of AUD and 58 (59.8%) without AUD. Adequacy of antidepressant medication treatment in the 3 previous months was assessed using the Antidepressant Treatment History Form. Compliance rates were estimated.
  
  
  RESULTS
  Rates of inadequate treatment were high in all patients. Bipolar patients with AUD (74.3%) showed higher rates of inadequate antidepressant treatment than those without AUD (67.3%). The proportion of intensive treatment was higher in bipolars without AUD (15.5%) than in those with AUD (2.6%). Median compliance was similar in bipolars with and without AUD.
  
  
  CONCLUSIONS
  We lack serum medication levels to assess the compliance. We do not have data to address the possibility that the presence of AUD adversely affected prescribing practices.
  
  
  CONCLUSIONS
  Bipolars with AUD had lower rates of adequate treatment than those without AUD, but the two groups were not different in terms of self-reported treatment adherence. The finding that bipolar patients with or without comorbid AUD did not receive adequate treatment is of considerable clinical relevance. It raises the question as to whether inadequate treatment of depression contributes to the high rates of morbidity, and attempted and completed suicides in bipolar patient populations.
authors.affiliation: Molecular Imaging and Neuropathology Division, NYS Psychiatric Institute and Columbia University, New York 10032, USA. moquendo@neuron.cpmc.columbia.edu
authors.forename: Enrique
authors.initials: E
authors.lastname: Baca-Garcia
authors.forename: Leo
authors.initials: L
authors.lastname: Sher
authors.forename: M Mercedes
authors.initials: MM
authors.lastname: Perez-Rodriguez
authors.forename: Ainsley K
authors.initials: AK
authors.lastname: Burke
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Sullivan
authors.forename: Michael F
authors.initials: MF
authors.lastname: Grunebaum
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Stanley
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000534:rehabilitation*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000453:epidemiology / Q000534:rehabilitation*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000534:rehabilitation; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000627:therapeutic use; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents; D011619:Psychotropic Drugs