Title

Antidepressant-induced mania with concomitant mood stabilizer in patients with comorbid substance abuse and bipolar disorder

Document Type

Journal Article

Publication Date

10-1-2009

Journal

Journal of Addictive Diseases

Volume

28

Issue

4

DOI

10.1080/10550880903182994

Keywords

Affective switching; Antidepressant-induced mania; Bipolar depression; Bipolar disorder; Bipolar II; Substance use disorder

Abstract

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.

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