Prospective, comparative, pilot study of maintenance treatment in comorbid bipolar disorders with post-traumatic stress disorder

Int Clin Psychopharmacol. 2025 Mar 1;40(2):75-83. doi: 10.1097/YIC.0000000000000543. Epub 2024 Feb 22.

Abstract

There is limited real-world evidence that evaluates the impact of monotherapy vs. combination therapy as a maintenance treatment in comorbid post-traumatic stress disorder (PTSD) in bipolar disorder (BD). Our aim was to compare lithium vs. lithium plus quetiapine in maintenance treatment in a sample of comorbid BD with PTSD. An exploratory, comparative pilot study over a 28-week period in 34 comorbid BD with PTSD patients was performed to compare monotherapy (n = 18) vs. combination therapy (n = 16) during maintenance treatment. The primary outcome was the time to event of recurrence of any mood episode. The secondary outcomes were regarding change from the baseline to endpoint in the Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). A Cox regression, Kaplan-Meir survival, and mixed-effects model for repeated measures analyses were performed. Lithium plus quetiapine reduces the risk of recurrence of any mood episode. There are significant differences between baseline and endpoint for YMRS, MADRS, and CGI-BP scales in the sample. In this pilot, exploratory analysis, combination therapy during maintenance treatment for comorbid BD with PTSD may be effective in preventing recurrences of any type of mood episode.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Antimanic Agents* / administration & dosage
  • Antimanic Agents* / therapeutic use
  • Antipsychotic Agents* / administration & dosage
  • Antipsychotic Agents* / therapeutic use
  • Bipolar Disorder* / drug therapy
  • Bipolar Disorder* / epidemiology
  • Comorbidity
  • Drug Therapy, Combination
  • Female
  • Humans
  • Lithium Compounds* / administration & dosage
  • Lithium Compounds* / therapeutic use
  • Male
  • Middle Aged
  • Pilot Projects
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Quetiapine Fumarate* / administration & dosage
  • Quetiapine Fumarate* / therapeutic use
  • Stress Disorders, Post-Traumatic* / drug therapy
  • Stress Disorders, Post-Traumatic* / epidemiology
  • Treatment Outcome

Substances

  • Quetiapine Fumarate
  • Antipsychotic Agents
  • Lithium Compounds
  • Antimanic Agents