Article Text

Download PDFPDF
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

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.



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


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.


Multiple centres, USA; 1999 to 2005.

Prognostic factors

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


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).



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 …

View Full Text


  • Sources of funding The National Institute on Alcoholism and Alcohol Abuse, the National Institute on Drug Abuse and the National Institute of Mental Health.


  • Competing interests None

Linked Articles