Article

Specificity of Bipolar Spectrum Conditions in the Comorbidity of Mood and Substance Use Disorders

Section on Developmental Genetic Epidemiology, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, 1A201 35 Convent Dr, MSC 3720, Bethesda, MD 20892-2670, USA.
Archives of general psychiatry (Impact Factor: 14.48). 02/2008; 65(1):47-52. DOI: 10.1001/archgenpsychiatry.2007.18
Source: PubMed

ABSTRACT

Although an association between mood disorders and substance use disorders has been well established, there is a lack of long-term prospective data on the order of onset and subtypes of mood disorders associated with specific substances and their progression.
To estimate the respective risks posed by subtypes of mood disorders or bipolar spectrum conditions for the subsequent development of substance use disorders.
Six waves of direct diagnostic interviews were administered to a sample of young adults during a 20-year period. Mood disorders and syndromes assessed at each interview were used to predict the cumulative incidences of substance use disorders at subsequent interview waves.
We followed up 591 individuals (292 men and 299 women) who were selected at study enrollment from a representative sample of young adults in Zurich, Switzerland.
Structured Diagnostic Interview for Psychopathologic and Somatic Syndromes, a semistructured clinical interview that collected data on the spectrum of expression of mood disorders and substance use and disorders for DSM-III-R and DSM-IV criteria.
Individuals having manic symptoms were at significantly greater risk for the later onset of alcohol abuse/dependence, cannabis use and abuse/dependence, and benzodiazepine use and abuse/dependence. Bipolar II disorder predicted both alcohol abuse/dependence and benzodiazepine use and abuse/dependence. In contrast, major depression was predictive only of later benzodiazepine abuse/dependence.
In comparison with major depression, bipolar II disorder was associated with the development of alcohol and benzodiazepine use and disorders. There was less specificity of manic symptoms that tended to predict all levels of the substances investigated herein. The different patterns of association between mood disorders and substance use trajectories have important implications for prevention and provide lacking information about underlying mechanisms.

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    • "Similarly to our findings among homeless populations, substance use is particularly common in those suffering from BD (Merikangas et al., 2008), and it has been associated with bipolarity in both full-blown expressions (Albanese et al., 2006;Bacciardi et al., 2013;Cassidy et al., 2001;Do and Mezuk, 2013;Elbogen and Johnson, 2009;Jaffee et al., 2009;Maremmani et al., 2008;Maremmani et al., 2006;Mitchell et al., 2007) and temperamental expressions (Maremmani et al., 2009;Pacini et al., 2009). Individuals with mania are 8.4 times more likely to experience lifetime drug dependence as compared to the general population (Do and Mezuk, 2013). "
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    • "Similar to Costello et al. (2007) and Farmer et al. (1999), our results demonstrate that bipolar disorder was far more likely to be treated among older than younger adolescents, likely because of greater comorbidity and severity. This finding is of particular importance for prevention in that early recognition and intervention for manic episodes may lead to the prevention of secondary disorders like substance use (Merikangas et al. 2008). Examining the relationship between age and patterns of treatment seeking and response in epidemiological samples is particularly crucial given recent evidence from nationally representative samples of potentially differentiable developmental trajectories of bipolar disorder (Cicero et al. 2009). "
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