Leo Sher, M.D.

Ten years ago, our research paper, “Treatment of depressed bipolar patients with alcohol use disorders: plenty of room for improvement” was published in the May 2009 issue of the Journal of Affective Disorders (1). We explored the adequacy of antidepressant treatment and compliance with treatment in bipolar patients with and without alcohol use disorders (AUD).

In all, 97 patients with current bipolar major depressive episode, 39 (40.2%) with lifetime history of AUD and 58 (59.8%) without AUD were included in the study. We observed that the rates of inadequate treatment were high in both groups. Bipolar patients with AUD showed higher rates of inadequate antidepressant treatment (74.3%) than those without AUD (67.3%). The proportion of intensive treatment was higher in bipolar patients without AUD (15.5%) than in those with AUD (2.6%). Median compliance was similar in both groups of patients.

Maybe, inadequate antidepressant treatment in bipolar patients with comorbid AUD is related to physician rather than patient behavior. It is possible that the presence of AUD adversely affects prescribing practices.

The fact that bipolar patients with or without comorbid AUD did not receive adequate treatment is of considerable clinical significance and raises the question as to whether inadequate treatment of depression contributes to the high rates of morbidity and suicide mortality in patients with bipolar disorder.

Reference

1. Baca-Garcia E, Sher L, Perez-Rodriguez MM, Burke AK, Sullivan GM, Grunebaum MF, Stanley BH, Mann JJ, Oquendo MA. Treatment of depressed bipolar patients with alcohol use disorders: plenty of room for improvement. J Affect Disord. 2009 May;115(1-2):262-8.