Antidepressant-induced mania with concomitant mood stabilizer in patients with comorbid substance abuse and bipolar disorder.
Antidepressant use in the treatment of bipolar disorder is controversial due the risks of affective switching and cycle acceleration. Studies of non-comorbid samples suggest that the risk can be mitigated with the use of a concomitant mood stabilizer. However, the majority of patients with bipolar disorder will experience a comorbid substance use disorder and little is known about these individuals because they are typically excluded from clinical trials. Patients entering a substance abuse treatment program who had a history of bipolar disorder were interviewed to evaluate antidepressant-induced affective switching with and without concomitant mood stabilizer. Among 41 comorbid participants, the total lifetime antidepressant-induced switch rate was 76%. The switch rate was 56% for patients taking a mood stabilizer and an antidepressant concomitantly. There was no difference between patients with bipolar I and bipolar II disorders.
Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2150 Pennsylvania Ave., NW, Washington, DC 20037, USA. dlieberman@mfa.gwu.edu
Daniel Z
DZ
Lieberman
George
G
Kolodner
Suena H
SH
Massey
Kenneth P
KP
Williams
D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D017831:Diagnosis, Dual (Psychiatry); D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires
D000928:Antidepressive Agents; D018692:Antimanic Agents