Substance Use Disorder and Other Predictors of Antidepressant-Induced Mania: A Retrospective Chart Review.
J Clin Psychiatry 2006;67(9):1341-1345
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To determine if substance use
disorder (SUD) is a predictor of antidepressant-induced mania (ADM) in bipolar disorder,
correcting for confounding factors in a regression model.
Method: 335 antidepressant trials were
identified in 98 patients treated in an academic
bipolar specialty clinic from 2000 to 2004. Patient
charts were reviewed, and histories of SUD and ADM (primary outcome; defined as a hypomanic
or manic episode within 12 weeks of beginning an antidepressant trial) were identified. Mood
disorder diagnoses were made using the Structured Clinical Interview for DSM-IV mood
module, and SUD diagnoses were defined using
DSM-IV criteria. Potential confounding variables
were also examined and included in a multivariable regression model. Concomitant mood
stabilizer, antimanic, and antidepressant use was
adjusted for in the regression model.
Results: In univariate analyses, there was
no evidence of an association between ADM and past SUD. However, after adjustment for
confounding variables in a multivariable
regression model, there was a strong relationship (OR
= 5.06, 95% CI = 1.31 to 19.64, p < .05). Other statistically significant predictors of ADM in
the regression model were type II subtype of
bipolar illness, female gender, and tricyclic
antidepressant (TCA) use (vs. bupropion).
Conclusions: Along with other factors, a
history of SUD was a strong predictor of ADM. Possible underestimation of ADM in
randomized clinical trials may occur due to the exclusion
of subjects with SUD. Type II illness, female gender, and TCA use also appeared to be
predictors of ADM, while bupropion use appeared to
predict lower likelihood of ADM.