Bipolar Disorder and Comorbid Use of Illicit Substances

Abstract

Substance use disorders (SUD) are highly prevalent in bipolar disorder (BD) and significantly affect clinical outcomes. Incidence and management of illicit drug use differ from alcohol use disorders, nicotine use of behavioral addictions. It is not yet clear why people with bipolar disorder are at higher risk of addictive disorders, but recent data suggest common neurobiological and genetic underpinnings and epigenetic alterations. In the absence of specific diagnostic instruments, the clinical interview is conducive for the diagnosis. Treating SUD in bipolar disorder requires a comprehensive and multidisciplinary approach. Most treatment trials focus on single drugs, such as cannabis alone or in combination with alcohol, cocaine, or amphetamines. Synopsis of data provides limited evidence that lithium and valproate are effective for the treatment of mood symptoms in cannabis users and may reduce substance use. Furthermore, the neuroprotective agent citicoline may reduce cocaine consumption in BD subjects. However, many of the available studies had an open-label design and were of modest to small sample size. The very few available psychotherapeutic trials indicate no significant differences in outcomes between BD with or without SUD. Although SUD is one of the most important comorbidities in BD with a significant influence on clinical outcome, there is still a lack both of basic research and clinical trials, allowing for evidence-based and specific best practices.

Bipolar Disorder and Polysubstance Use Disorder: Sociodemographic and Clinical Correlates

“…The present paper aimed to evaluate the factors associated with SUD and polySUD in a cohort of patients with BD. Evidence from epidemiological, clinical, and review studies has shown that the comorbidity between patients with a primary diagnosis of BD and SUD is frequent ( 23 , 27 , 28 , 35 ). This has also been confirmed in our sample.…”

“…The reasons why patients with BD use illicit substances are different, including seeking relief by self-medication, improving psychic status, relieving tension and boredom, escaping from reality, achieving and/or maintaining elevated mood, and increasing energy ( 27 ). Furthermore, common genetic (i.e., polymorphism of the aldehyde hydrogenase and alcohol dehydrogenase, or 5HT 2C gene), socioeconomic, and environmental factors (i.e., access and availability of illicit drugs in the community, poverty), stressful events (i.e., trauma, physical, and sexual abuse), temperamental traits (i.e., a sensation of seeking behavior), lifetime suicide attempts, and psychiatric comorbidities (i.e., conduct disorder, cluster B personality disorder, and post-traumatic stress disorder) have been associated with SUD in patients with BD ( 24 , 28 , 29 ).…”

“…The comorbidity between BD and SUD is associated with several detrimental clinical characteristics, such as an earlier onset of illness, greater severity of the disorder, more rapid cycling with a higher risk of switching into (hypo)manic or mixed phases and frequent affective relapses, increased risk of suicide attempts or suicide, and accelerated progression of BD with higher prevalence of negative and cognitive symptomatology. Furthermore, patients affected by BD and SUD are characterized by treatment delay due to possible misdiagnosis, reduced response to lithium and other pharmacological treatments with worsening of adherence, presence of medical comorbidities (hepatitis C, acquired immune deficiency syndrome, and others), increased psychosocial problems, and poorer social support ( 27 , 28 , 30 ). Finally, illicit substances, particularly cannabis, are considered risk factors for the onset of BD ( 31 , 32 ).…”

New treatment strategies for bipolar disorder in the elderly

“…[27] A significant number of patients with bipolar disorder use drugs or alcohol instead of pharmacotherapy. Both depressed mood in depressive states and substance abuse are significantly associated with episodes of suicide attempts [28].…”

Bipolar Affective Disorder: The Psychodynamic Approach of Etiology

“…However, more and more studies highlight cannabis as a risk factor and examine the relationship between the frequency of consumption, age of the consumer, and the onset or severity of bipolar disorder (Lalli, Brouillette, Kapczinski, & de Azevedo Cardoso, 2021). For opioids, alcohol, and drugs, prospective studies show that they increase the risk associated with bipolar disorder, without examining the specific differences (Preuss, Schaefer, Born, & Grunze, 2021).…”