Journal of addictive diseases : the official journal of the ASAM, American Society of Addiction Medicine
Adult; Antidepressive Agents; Antimanic Agents; Bipolar Disorder; Comorbidity; Depressive Disorder, Major; Diagnosis, Dual (Psychiatry); District of Columbia; Female; Humans; Interviews as Topic; Male; Middle Aged; Psychiatric Status Rating Scales; Substance Abuse Treatment Centers; Substance-Related Disorders; Surveys and Questionnaires
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.
Lieberman, D., Kolodner, G., Massey, S., & Williams, K. (2009). Antidepressant-induced mania with concomitant mood stabilizer in patients with comorbid substance abuse and bipolar disorder.. Journal of addictive diseases : the official journal of the ASAM, American Society of Addiction Medicine, 28 (4). http://dx.doi.org/10.1080/10550880903182994