Depression Precipitated by Alcohol Use in Patients With Co-Occurring Bipolar and Substance Use Disorders

Jaffee, William B.; Griffin, Margaret L.; Gallop, Robert; Meade, Christina S.; Graff, Fiona S.; Bender, Rachel E.; Weiss, Roger D.

doi:10.4088/jcp.08m04011

Cited by 41 publications

(38 citation statements)

References 20 publications

(30 reference statements)

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“…In fact, in our study  we found that they differ for predominant polarity. The depressive prevalent polarity we found in BD patients with AUD is in line with the previously observed association between alcohol abuse and increased frequency of depressive episodes in BD [12, 23]. Accordingly, this finding may  also be consistent with the decrease in alcohol abuse longitudinally observed in a group with manic predominant polarity [11].…”

Section: Discussionsupporting

confidence: 92%

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Who’s the Leader, Mania or Depression? Predominant Polarity and Alcohol/Polysubstance Use in Bipolar Disorders

Janiri

Nicola

Martinotti

et al. 2017

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Background: Predominant polarity characterises patients who mainly manifest recurrences of depression or mania/hypomania. Alcohol use disorder (AUD) and polysubstance use (PSU), which often complicate bipolar disorder (BD) and affect its clinical course, can influence predominant polarity. Nevertheless, previous studies have not clarified if BD patients differ in predominant polarity from BD patients with substance use disorder (SUD) comorbidity.Objective: The aim of this study was to compare predominant polarity between BD without SUD, BD with AUD and BD with PSU. We also investigated the association between predominant polarity and first episode polarity in each diagnostic group.Method: We evaluated predominant polarity (≥2:1 lifetime depressive vs. manic/hypomanic episodes) in 218 DSM-IV-TR BD patients. Specifically, data were obtained from 86 patients with BD without SUD, 69 patients with BD and AUD, and 63 patients with BD and PSU with alcohol as the primary substance abused.Results: The three groups significantly differed for predominant polarity. The most common predominant polarity in BD without SUD was manic, while in BD with AUD and in BD with PSU it was depressive. Uncertain predominant polarity was the least common in BD without SUD and BD with PSU, whereas in BD with AUD, manic predominant polarity was least common. Predominant polarity matched onset polarity in all groups.Conclusion: BD without SUD, BD with AUD, and BD with PSU have different predominant polarities. The correspondence between predominant polarity and polarity at the onset may impact diagnosis and treatment of BD.

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Section: Discussionsupporting

confidence: 92%

“…Nevertheless, a recent prospective study found a significant longitudinal decrease of alcohol/ other drug abuse during the course of the illness in the manic predominant polarity group [11]. Moreover, another study found increased frequency of depressive episodes in patients with comorbid BD and AUD [12]. …”

Section: Introductionmentioning

confidence: 99%

Who’s the Leader, Mania or Depression? Predominant Polarity and Alcohol/Polysubstance Use in Bipolar Disorders

Janiri

Nicola

Martinotti

et al. 2017

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“…Similarly to our findings among homeless populations, substance use is particularly common in those suffering from BD (Merikangas et al, 2008), and it has been associated with bipolarity in both full-blown expressions (Albanese et al, 2006;Bacciardi et al, 2013;Cassidy et al, 2001;Do and Mezuk, 2013;Elbogen and Johnson, 2009;Jaffee et al, 2009;Maremmani et al, 2008;Maremmani et al, 2006;Mitchell et al, 2007) and temperamental expressions Pacini et al, 2009). Individuals with mania are 8.4 times more likely to experience lifetime drug dependence as compared to the general population (Do and Mezuk, 2013).…”

Section: Substance Use and Bipolar Disordersupporting

confidence: 83%

Substance Use Among Homeless Individuals With Schizophrenia and Bipolar Disorder

Maremmani¹,

Bacciardi²,

Gehring³

et al. 2017

J Nerv Ment Dis

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Mental illness and substance use are overrepresented within urban homeless populations. This paper compared substance use patterns between homeless individuals diagnosed with schizophrenia spectrum (SS) and bipolar disorders (BD) using the Mini-International Neuropsychiatric Interview. From a sample of 497 subjects drawn from Vancouver, Canada who participated in the At Home/Chez Soi study, 146 and 94 homeless individuals were identified as BD and SS, respectively. In the previous 12 months, a greater proportion of BD homeless reported greater use of cocaine (χ = 20.0, p = 0.000), amphetamines (χ = 13,8, p = 0.000), opiates (χ = 24.6, p = 0.000), hallucinogens (χ = 11.7, p = 0.000), cannabinoids (χ = 5.05, p = 0.034), and tranquilizers (χ = 7.95, p = 0.004) compared to SS. Cocaine and opiates were significantly associated with BD homeless (χ = 39.06, df = 2, p < 0.000). The present study illustrates the relationship between substance use and BD in a vulnerable urban population of homeless, affected by adverse psychosocial factors and severe psychiatric conditions.

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“…However, in persons for whom bipolar disorder symptoms were resolved with mood-stabilizing medications, or symptoms of major depression with antidepressants, substance use typically was not affected by the medication, alcohol or drug use continued. Sometimes this affected recovery from the mood disorder (35), and in other cases it did not (36,37).…”

Section: Discussionmentioning

confidence: 99%

Current Status of Co-Occurring Mood and Substance Use Disorders: A New Therapeutic Target

Pettinati¹,

O’Brien²,

Dundon³

2015

FOC

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Mood and substance use disorders commonly co-occur, yet there is little evidence-based research to guide the pharmacologic management of these comorbid disorders. The authors review the existing empirical findings, some of which may call into question current clinical pharmacotherapy practices for treating co-occurring mood and substance use disorders. The authors also highlight knowledge gaps that can serve as a basis for future research. The specific mood disorders reviewed are bipolar and major depressive disorders (either one co-occurring with a substance use disorder). Overall, findings from the relatively small amount of available data indicate that pharmacotherapy for managing mood symptoms can be effective in patients with substance dependence, although results have not been consistent across all studies. Also, in most studies, medications for managing mood symptoms did not appear to have an impact on the substance use disorder. In a recent trial for comorbid major depression and alcohol dependence, combination treatment with a medication for depression and another for alcohol dependence was found to reduce depressive symptoms and excessive drinking simultaneously. However, research has only begun to address optimal pharmacologic management of co-occurring disorders. In addition, current clinical treatment for alcohol and drug dependence often excludes new pharmacotherapies approved by the U.S. Food and Drug Administration for treating certain types of addiction. With new data becoming available, it appears that we need to revisit current practice in the pharmacological management of co-occurring mood and substance use disorders.

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Depression Precipitated by Alcohol Use in Patients With Co-Occurring Bipolar and Substance Use Disorders

Cited by 41 publications

References 20 publications

Who’s the Leader, Mania or Depression? Predominant Polarity and Alcohol/Polysubstance Use in Bipolar Disorders

Who’s the Leader, Mania or Depression? Predominant Polarity and Alcohol/Polysubstance Use in Bipolar Disorders

Substance Use Among Homeless Individuals With Schizophrenia and Bipolar Disorder

Current Status of Co-Occurring Mood and Substance Use Disorders: A New Therapeutic Target

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