Leo Sher, M.D.

Fifteen years ago, our research work, “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). Bipolar disorder is often inadequately treated. Patients with bipolar disorder show high rates of treatment nonadherence. Moreover, treatment may be negatively influenced by alcohol use disorders (AUD).

In this study, we examined the adequacy of antidepressant treatment and compliance with treatment in bipolar patients with or without AUD. We hypothesized that the adequacy of antidepressant treatment and the compliance with treatment for those with AUD were lower than for those without 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.

Inadequate antidepressant treatment in bipolar patients with comorbid AUD may be related to physician rather than patient behavior. Possibly, the presence of AUD adversely affects prescribing practices. AUD is highly stigmatized and both individuals with current AUD and individuals with AUD in remission may be treated differently compared to non-AUD patients.

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. doi: 10.1016/j.jad.2008.09.012. Epub 2008 Oct 29.