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Publications

Journal Article Ppublish

PubMed: 42578538 DOI: 10.1111/bdi.70167

Prescription Trends for Bipolar Disorder With and Without Comorbid Substance Use and Anxiety Disorders: A Global Bipolar Cohort Collaborative Study.

Bipolar Disord 28(6):e70167

Authors: Anastasia K Yocum, Martin Alda, Bruno Aouizerate, Valerie Aubin, Frank Bellivier, Raoul Belzeaux, Michael Berk, Joanna M Biernacka, Monika Budde, Katherine E Burdick, Yun-Hsuan Chang, Brandon J Coombes, Philippe Courtet, Nina Dalkner, Claudia Diaz-Byrd, Caroline Dubertret, Bruno Etain, Giovanna Fico, Janice M Fullerton, Ophelia Godin, Katherine Gordon-Smith, Emmanuel Haffen, Dominique Januel, Kamyar Keramatian, Marion Leboyer, Antoine Lefrere, Pierre-Michel Llorca, Marzieh Majd, Philip B Mitchell, Benson Mwangi, Emilie Olie, Bronwyn J Overs, Joanne Petite, Mircea Polosan, Romain Rey, Gloria Roberts, Paul Roux, Ludovic Samalin, Raymund Schwan, Alessandro Serretti, Jair C Soares, Sarah H Sperry, Rebecca Strawbridge, Tatjana Stross, Eduard Vieta, Michel Walter, Lana J Williams, Mon-Ju Wu, Lakshmi N Yatham, Allan H Young … and 5 other authors

Affiliations

  • Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
  • Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
  • Fondation FondaMental, Creteil, France.
  • Centre Hospitalier Charles Perrens, Laboratoire NutriNeuro (UMR INRA 1286), Université de Bordeaux, Bordeaux, France.
  • Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, Monaco.
  • Optimisation Thérapeutique en Neuropharmacologie, Université Paris Cité, INSERM UMRS 1144, Paris, France.
  • Département de Psychiatrie et de Médecine Addictologique, Hôpitaux Lariboisière-Fernand Widal, DMU Neurosciences, AP-HP.Nord, Université Paris Cité, Paris, France.
  • Department of Psychiatry and Addictology, University Hospital Center, Montpellier, France.
  • IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.
  • Deakin Institute for Mental and Physical Health and Clinical Translation (Deakin IMPACT), School of Medicine, Deakin University, Melbourne, Victoria, Australia.
  • Mental Health Drug and Alcohol Services, Barwon Health, University Hospital Geelong, Geelong, Australia.
  • Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.
  • Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
  • Institute of Psychiatric Phenomics and Genomics (IPPG), LMU University Hospital, LMU Medizin, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.
  • New York State Psychiatric Institute, New York, New York, USA.
  • Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
  • Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
  • Department of Psychology, National Cheng Kung University, Tainan, Taiwan.
  • Department of Emergency Psychiatry and Acute Care, CHU Montpellier, IGF, Univ. Montpellier, CNRS, Inserm, Montpellier, France.
  • Division of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
  • AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France Université de Paris Inserm UMR1266, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
  • Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
  • Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
  • Neuroscience Research Australia, Sydney, New South Wales, Australia.
  • Centre for Mental Health & Brain Sciences, School of Health Sciences, Swinburne University of Technology, Victoria, Australia.
  • Departement Medico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Université Paris Est Créteil (UPEC), INSERM, IMRB U955, Laboratoire Neuro-psychiatrie translationnelle and centre expert Bipolaire AP-HP, Hopital Henri Mondor, Creteil, France.
  • BDRN University of Worcester, UK.
  • Université Marie et Louis Pasteur, UMR INSERM 1322 LINC, Service de Psychiatrie de L'adulte, CIC-1431 INSERM, Besançon, France.
  • Département de Recherche Clinique, pôle Universitaire 93G03, EPS Ville Evrard Neuilly Sur Marne, Université Sorbonne Paris-Nord, Unité Inserm U955, Neuilly-sur Marne, France.
  • Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
  • Department of Psychiatry, Clermont-Ferrand University Hospital, University of Clermont Auvergne, CNRS, IP, UMR 6602, Clermont-Ferrand, France.
  • Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.
  • Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
  • School of Behavioral Health Sciences, University of Texas Health Sciences Center at Houston, Texas, USA.
  • Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
  • Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.
  • Bipolar Disorder Expert Centre, Le Vinatier Hospital, Bron, France.
  • University Lyon 1, Villeurbanne, France.
  • Inserm U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders, Neuroscience Research and Clinical Research Team, Lyon, France.
  • Lyon Neuroscience Research Center, Psychiatric Disorders, Neuroscience Research and Clinical Research Team, Lyon, France.
  • Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie D'adulte et D'addictologie, Le Chesnay, France.
  • Service de Psychiatrie du Secteur 78G18, Centre Hospitalier de Plaisir, Plaisir, France.
  • DisAP, MOODS Team, INSERM UMR1018, CESP, Université de Versailles Saint-Quentin-En-Yvelines - Université Paris-Saclay, Le Chesnay, France.
  • Université de Lorraine, Nancy, France.
  • Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie CEReSS/EA 3279; Hôpitaux Universitaires de Marseille, Marseille, France.
  • Department of Medicine and Surgery, Kore University of Enna, Enna, Italy.
  • Oasi Research Institute-IRCCS, Troina, Italy.
  • Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
  • Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
  • Fundació Clínic-Institut D'investigacions Biomèdiques August pi I Sunyer (IDIBAPS), Barcelona, Spain.
  • Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain.
  • CHRU de Brest, Hôpital de Bohars, Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02, Brest, France.

Abstract

OBJECTIVES

To investigate pharmacological treatment patterns in individuals with bipolar disorder (BD) with and without comorbid substance use disorder (SUD) and anxiety disorder (AX), we leveraged the Global Bipolar Cohort to analyze cross-regional practices across North America, Europe, and the Pacific.

METHODS

Fourteen cohorts contributed aggregate data on pharmacotherapy, demographics, diagnostic subtypes, and comorbidities. Proportional meta-analyses using generalized linear mixed models were conducted to examine prescription trends and identify clinical differences.

RESULTS

The sample (N = 11,521) was 60% female and 84% Caucasian. Participants were categorized into four mutually exclusive groups based on comorbidity status: those with comorbid AX only, comorbid SUD only, both AX and SUD, or neither. The AX+SUD subgroup showed higher rates of attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), rapid cycling, obesity, and unemployment, reflecting a more severe clinical profile. Regional variations were notable: North American cohorts reported higher prevalence of AX and SUD than European and Pacific cohorts. Antidepressants use for AX were more common in Europe and the Pacific, while North American prescribing patterns were more variable. Benzodiazepine use was high among individuals with SUD across all regions. Lithium and first-generation antipsychotic prescriptions varied, with higher rates observed in Europe.

CONCLUSIONS

Findings underscore the heterogeneity of BD and the influence of comorbid AX and SUD on illness burden and treatment. Regional prescribing variations underscore the need for context-specific guidelines. Gaps in data on medication-assisted treatment for SUD point to areas for future research. These insights can support more individualized and effective care for complex BD presentations.

MeSH

Comorbidity, Bipolar Disorder, Stress Disorders, Post-Traumatic, Prescriptions, Psychopharmacology, Stress Disorders, Traumatic, Anxiety Disorders, Therapeutics, Attention Deficit Disorder With Hyperactivity