Antidepressant-induced mania with concomitant mood stabilizer in patients with comorbid substance abuse and bipolar disorder

J Addict Dis. 2009 Oct;28(4):348-55. doi: 10.1080/10550880903182994.


Antidepressant use in the treatment of bipolar disorder is controversial due the risks of affective switching and cycle acceleration. Studies of non-comorbid samples suggest that the risk can be mitigated with the use of a concomitant mood stabilizer. However, the majority of patients with bipolar disorder will experience a comorbid substance use disorder and little is known about these individuals because they are typically excluded from clinical trials. Patients entering a substance abuse treatment program who had a history of bipolar disorder were interviewed to evaluate antidepressant-induced affective switching with and without concomitant mood stabilizer. Among 41 comorbid participants, the total lifetime antidepressant-induced switch rate was 76%. The switch rate was 56% for patients taking a mood stabilizer and an antidepressant concomitantly. There was no difference between patients with bipolar I and bipolar II disorders.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antidepressive Agents / adverse effects*
  • Antidepressive Agents / therapeutic use
  • Antimanic Agents / therapeutic use
  • Bipolar Disorder / chemically induced*
  • Bipolar Disorder / drug therapy
  • Bipolar Disorder / epidemiology
  • Bipolar Disorder / psychology
  • Comorbidity
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / psychology
  • Diagnosis, Dual (Psychiatry)
  • District of Columbia / epidemiology
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Substance Abuse Treatment Centers
  • Substance-Related Disorders / drug therapy*
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / psychology*
  • Surveys and Questionnaires


  • Antidepressive Agents
  • Antimanic Agents