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Past or current drug or alcohol use disorders increase the likelihood of a switch from depressive to manic, mixed or hypomanic states in patients with bipolar disorder

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Question

Question

How does comorbid substance abuse affect recovery from major depressive episodes in patients with bipolar disorder?

Population

A total of 3,750 adults with DSM-IV bipolar I or bipolar II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Analyses included 2,154 participants who experienced a depressive episode during the study and completed at least one follow-up visit after the onset of this episode.

Setting

Multiple centres, USA; 1999 to 2005.

Prognostic factors

Current or past alcohol or drug use disorder (assessed using the Mini-International Neuropsychiatric Interview).

Outcomes

Time to remission from depressive episode (no more than two syndromal features of depression for at least 8 weeks); switch to a manic, hypomanic or mixed episode (meeting full DSM-IV criteria on any follow-up visit).

Methods

Design

Cohort study.

Follow up period

24 months from the start of a depressive episode.

Main results

Of the participants who experienced depressive episodes, 8% had a current alcohol use disorder and 32.2% had a past alcohol use disorder, 7.3% had a current drug use disorder and 21.7% had a past drug use disorder. There was …

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