Update on Bipolar Disorder and Substance Abuse: Recent Findings and Treatment Strategies
J Clin Psychiatry 2006;67(9):e10
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Between 40% and 70% of people with bipolar disorder have a history of substance
use disorder. A current or past comorbid substance use disorder may lead to
worse outcomes for bipolar disorder, including more symptoms, more suicide
attempts, longer episodes, and lower quality of life. Unfortunately, few
treatments have been studied in patients with both illnesses, and large
controlled trials are needed. Evidence from small studies suggests that some
treatments proven for bipolar disorder (e.g., divalproex, lithium, quetiapine,
lamotrigine, and psychotherapy) may decrease substance abuse or dependence. Both
the bipolar disorder and the substance use disorder should be considered when
determining the best management strategy. Once treatment has begun, clinicians
should ensure that medication and psychotherapy are administered appropriately
and that treatment is modified when there is inadequate response.
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