A history of substance abuse complicates remission from acute mania in bipolar disorder

Background: Substance abuse frequently complicates the course of bipolar il lness, promotes mixed states, and contributes to poor outcome in mania. Pre liminary open trials suggest that anticonvulsant mood stabilizers may enhan ce remission rates and outcome for bipolar patients with substance abuse. T his study compared remission patterns for mixed or pure manic episodes amon g bipolar inpatients with or without substance abuse histories. Method: Hospital records were retrospectively reviewed far 204 DSM-LII-R bi polar I inpatients. Clinical features were compared for those with or witho ut substance abuse/dependence histories predating the index manic episode. Time until remission was analyzed by Kaplan-Meier survival analysis. Natura listic treatment outcome with lithium or anticonvulsant mood stabilizers wa s compared for those with or without past substance abuse. Results: Past substance abuse was evident in 34% of the bipolar sample and comprised most often alcoholism (82%), followed by cocaine (30%), marijuana (29%), sedative-hypnotic or amphetamine (21%), and opiate (13%) abuse. Sub stance abuse was more common among men (p < .05) and those with mixed rathe r than pure mania (p < .05). Remission during hospitalization was less like ly among patients with prior substance abuse (p < .05), especially alcohol or marijuana abuse, and among mixed manic patients with past substance abus e (p < .05). Bipolar patients With substance abuse histories who received d ivalproex or carbamazepine remitted during hospitalization more often than did those who received lithium as the sole mood stabilizer (p < .05). Conclusion: These findings support previous reports suggesting that bipolar patients with past substance abuse have poorer naturalistic treatment outc omes, but may show a better response to anticonvulsant mood stabilizers tha n lithium.