Antidepressant-Induced Mania with Concomitant Mood Stabilizer in Patients with Comorbid Substance Abuse and Bipolar 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.

KEYWORDS:

• Bipolar disorder
• bipolar II
• substance use disorder
• antidepressant-induced mania
• affective switching
• bipolar depression

Daniel Z. Lieberman has received honoraria from GlaxoSmithKline and research support from AstraZeneca, Bristol Myers Squibb, Cenerex, Comentis, Eli Lilly, Epix, McNeil, Ono, Predix, Sanofi Aventis, Takeda, and Wyeth. Suena H. Massey has received research support from Bristol Myers Squibb, Eli Lilly, Ono, Takeda, and Cenerex. Kenneth P. Williams has received research support from AstraZeneca, Bristol Myers Squibb, Cenerex, Comentis, Eli Lilly, Epix, McNeil, Ono, Predix, Sanofi Aventis, Takeda, and Wyeth.

Notes

^a Continuous measures shown as averages with standard deviations in parentheses. Discreet measures are shown as the number of patients with percentages in parentheses.