title: Effects of antidepressant use and anxiety on psychiatric rehospitalization in bipolar depression.
abstract: BACKGROUND
  This study was designed to quantify adjunctive antidepressant use in bipolar depression and investigate whether the use of adjunctive antidepressants or presence of comorbid anxiety impacted the rate of psychiatric rehospitalization.
  
  
  METHODS
  Charts were reviewed for 377 adult patients with bipolar I depression discharged from Butler Hospital, a nonprofit psychiatric hospital in Providence, Rhode Island, from January 2008 to July 2011. Primary outcomes were impact of antidepressant exposure on readmission rates and time to readmission in the year post-discharge. Secondary analyses examined outcomes associated with anxiety, antidepressant class, and affective switch.
  
  
  RESULTS
  Of the 377 patients, 233 (61.8%) were prescribed an antidepressant at discharge and 144 (38.2%) were not. Only serotonin-norepinephrine reuptake inhibitor (SNRI) exposure, compared with nonexposure, was associated with greater readmission (74.4% vs 56.7%, P=.008) and shorter time to readmission (165±145 vs 210±153 days, P=.021). No antidepressant was associated with affective switch (P>.1). The presence of comorbid anxiety predicted readmission (66.4% vs 52.2%, P=.013), time to readmission (191±153 vs 220±153 days, P=.036), and affective switch (HR=8.60, CI, 2.54 to 29.15, P<.001).
  
  
  CONCLUSIONS
  In this study, being prescribed an antidepressant for bipolar depression had no significant impact on psychiatric hospital readmission. SNRIs were associated with poorer outcomes, as was the presence of comorbid anxiety.
authors.affiliation: Laboratory for Clinical and Translational Neuroscience Butler Hospital, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA. E-mail: noah_philip@brown.edu.
authors.forename: Kalya
authors.initials: K
authors.lastname: Vardi
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Warner
authors.forename: Noah S
authors.initials: NS
authors.lastname: Philip
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012237:Rhode Island; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors / Q000627:therapeutic use*
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D018692:Antimanic Agents; D017367:Selective Serotonin Reuptake Inhibitors; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors