Benzodiazepine Use and Risk of Recurrence in Bipolar Disorder

Perlis, Roy H.; Ostacher, Michael J.; Miklowitz, David J.; Smoller, Jordan W.; Dennehy, Ellen B.; Cowperthwait, Colleen M.; Nierenberg, Andrew A.; Thase, Michael E.; Sachs, Gary S.

doi:10.4088/jcp.09m05019yel

Cited by 45 publications

(38 citation statements)

References 30 publications

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“…Moreover, BZDs are commonly used in the patients with newly diagnosed bipolar disorder despite not recommended in the clinical guideline. [6][7][8][9][10] In the study of Systematic Treatment Enhancement Program for BD, Perlis et al 45 reported that BZD use was associated with increased risk for recurrence of a mood episode among patients with bipolar 1 and 2 disorder. 45 Most guidelines have recommended different first-line, second-line, and third-line agents by different phases of bipolar disorder.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10] In the study of Systematic Treatment Enhancement Program for BD, Perlis et al 45 reported that BZD use was associated with increased risk for recurrence of a mood episode among patients with bipolar 1 and 2 disorder. 45 Most guidelines have recommended different first-line, second-line, and third-line agents by different phases of bipolar disorder. [6][7][8]46 However, this study investigated trends and patterns of pharmacological treatment among patients with newly diagnosed bipolar disorders in their first year of treatment and did not separate them by manic or mixed, depression, or maintenance phases.…”

Section: Discussionmentioning

confidence: 99%

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Utilization of Psychopharmacological Treatment Among Patients With Newly Diagnosed Bipolar Disorder From 2001 to 2010

Chang¹,

Wu²,

Huang³

et al. 2016

Journal of Clinical Psychopharmacology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Utilization of Psychopharmacological Treatment Among Patients With Newly Diagnosed Bipolar Disorder From 2001 to 2010

Chang¹,

Wu²,

Huang³

et al. 2016

Journal of Clinical Psychopharmacology

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“…The 5-year prevalence of BZD use among patients with BD with and without comorbid substance use disorder was reported to be 75% and 58%, respectively 81. Moreover, adjunctive BZD use at the time of symptom remission has been linked with higher risk of mood episode recurrence, as compared with no BZD use, in patients with BD-I and BD-II 82. However, some studies report no significant effect of BZD use on any outcome measure in patients with BD with comorbid anxiety or substance use disorders 83.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, impact and treatment of generalised anxiety disorder in bipolar disorder: a systematic review and meta-analysis

Preti

Vrubļevska

Veroniki

et al. 2016

Evid Based Mental Health

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Question Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression; however, less attention has been paid to comorbidity of anxiety disorders with BD. Generalised anxiety disorder (GAD) is one of the most prevalent anxiety disorders that is highly comorbid with other mental disorders. We carried out a systematic review and meta-analysis to assess the degree of comorbidity between GAD and BD. Study selection and analysis We searched for all studies, which included primary data concerning the existence of GAD in patients with BD. The literature search strategy, selection of publications and the reporting of results have been conducted with PRISMA guidelines. The meta-analysis calculated prevalence estimates using the variance-stabilising Freeman-Tukey double arcsine transformation. We applied the inverse variance method using both fixed-effects and random-effects models to estimate summary effects for all combined studies. Heterogeneity was assessed and measured with Cochran's Q and I 2 statistics, respectively. Findings The current meta-analysis analysed data from 28 independent studies and a total of 2975 patients from point prevalence studies and 4919 patients from lifetime studies. The overall random-effects point prevalence of GAD in patients with BD was 12.2% (95% CI 10.9% to 13.5%) and the overall random-effects lifetime estimate was 15.1% (95% CI 9.7% to 21.5%). Both estimates reported significant heterogeneity (94.0% and 94.7%, respectively). Conclusions Published studies report prevalence rates with high heterogeneity and consistently higher than those typically reported in the general population. It is believed that comorbid GAD might be associated with a more severe BD course and increased suicidality, and it is unknown how best to treat such conditions. The current meta-analysis confirms that GAD is highly prevalent in BD and the rate is higher in comparison to those in the general population.

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“…Outside of acute settings, this approach is controversial due to the abuse liability and lack of controlled evidence about the long-term safety and effectiveness of benzodiazepines as adjuncts to foundational mood stabilizing medications such as lithium, selected anticonvulsants, and atypical antipsychotics (Brunette et al, 2003). Adjunctive benzodiazepine use at the time of symptom remission has been linked with higher risk of mood episode recurrence, as compared with no benzodiazepine use, in patients with bipolar I or II disorder (Perlis et al, 2010). On the other hand, effects of adjunctive benzodiazepines on core bipolar mood symptoms and associated symptoms such as anxiety and irritability have not been extensively investigated, and little is known about benzodiazepine treatment outcomes in bipolar disorder patients with comorbid anxiety and alcohol use disorders.…”

Section: Introductionmentioning

confidence: 99%

Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar I or II disorder: Results from the Bipolar CHOICE trial

Bobo

Reilly-Harrington

Ketter

et al. 2014

Journal of Affective Disorders

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Background Little is known about the longer-term effects of adjunctive benzodiazepines on symptom response during treatment in patients with bipolar disorders. Methods The study sample consisted of 482 patients with bipolar I or II disorder enrolled in a 6-month, randomized, multi-site comparison of lithium- and quetiapine-based treatment. Changes in clinical measures (BISS total and subscales, CGI-BP, and CGI-Efficacy Index) were compared between participants who did and did not receive benzodiazepine treatment at baseline or during follow-up. Selected outcomes were also compared between patients who did and did not initiate benzodiazepines during follow-up using stabilized inverse probability weighted analyses. Results Significant improvement in all outcome measures occurred within each benzodiazepine exposure group. Benzodiazepine users (at baseline or during follow-up) experienced significantly less improvement in BISS total, BISS irritability, and CGI-BP scores than did benzodiazepine non-users. There were no significant differences in these measures between patients who did and did not initiate benzodiazepines during follow-up in the weighted analyses. There was no significant effect of benzodiazepine use on any outcome measure in patients with comorbid anxiety or substance use disorders. Limitations This is a secondary analysis of data from a randomized effectiveness trial that was not designed to address differential treatment response according to benzodiazepine use. Conclusions Adjunctive benzodiazepines may not significantly affect clinical outcome in lithium- or quetiapine-treated patients with bipolar I or II disorder over 6 months, after controlling for potential confounding factors.

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Benzodiazepine Use and Risk of Recurrence in Bipolar Disorder

Abstract: Benzodiazepine use may be associated with greater risk for recurrence of a mood episode among patients with bipolar I and II disorder. The prescribing of benzodiazepines, at a minimum, appears to be a marker for a more severe course of illness.

Cited by 45 publications

References 30 publications

Utilization of Psychopharmacological Treatment Among Patients With Newly Diagnosed Bipolar Disorder From 2001 to 2010

Utilization of Psychopharmacological Treatment Among Patients With Newly Diagnosed Bipolar Disorder From 2001 to 2010

Prevalence, impact and treatment of generalised anxiety disorder in bipolar disorder: a systematic review and meta-analysis

Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar I or II disorder: Results from the Bipolar CHOICE trial

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