Diagnosing and Treating Comorbid (Complicated) Bipolar Disorder
J Clin Psychiatry 2004;65(suppl 15):35-44
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Comorbidity is the rule, not the exception, in bipolar disorder. The most common mental disorders
that co-occur with bipolar disorder in community studies include anxiety, substance use, and conduct
disorders. Disorders of eating, sexual behavior, attention-deficit/hyperactivity, and impulse control, as
well as autism spectrum disorders and Tourette’s disorder, co-occur with bipolar disorder in clinical
samples. The most common general medical comorbidities are migraine, thyroid illness, obesity, type
II diabetes, and cardiovascular disease. Bipolarity is a marker for comorbidity, and comorbid disorders,
especially multiple conditions occurring when a patient is young, may be a marker for bipolarity.
Relatively few controlled clinical studies have examined the treatment of bipolar disorder in the context
of comorbid conditions (i.e., complicated or comorbid bipolar disorder). However, the first step
in treating any type of complicated bipolar disorder—stabilizing a patient’s mood—may be associated
with improving the comorbid disorder. Standard mood stabilizers, atypical antipsychotics, and nonantimanic
antiepileptic agents are emerging as potentially useful treatments for several of the
disorders that frequently co-occur with bipolar disorder, and therefore may be useful treatments for
comorbid bipolar disorder.