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25-08-2010 | Mental health | Article

Anxiety linked to substance use problems in bipolar disorder


Free abstract

MedWire News: Patients with bipolar disorder (BD) who suffer from anxiety are at increased risk for substance use disorders (SUDs), research shows.

The findings indicate that timely treatment of anxiety may reduce the risk for SUDs in BD patients, say Keming Gao (Case Western Reserve University School of Medicine, Cleveland, Ohio, USA) and team.

Writing in the American Journal on Addictions, the researchers explain that previous studies have shown high rates of anxiety disorders and SUDs in patients with BD compared with the general population.

However, they add that few studies have assessed the risk for SUDs associated with anxiety disorders specifically in BD patients.

To investigate independent predictors for lifetime and recent SUDs in patients with rapid-cycling BD, with a particular focus on anxiety disorders, the team studied data from four similar clinical trials on 568 patients with the mood condition, who were aged an average of 36 years.

The Extensive Clinical Interview and the Mini-International Neuropsychiatric Interview were used to assess the prevalence of anxiety disorders and SUDs among the patients.

Univariate analysis revealed that the 261 patients with co-morbid anxiety disorders (generalized anxiety disorder [GAD], panic disorder, or obsessive compulsive disorder) had significantly increased risks for lifetime and recent alcohol dependence (odds ratios [ORs]= 2.1 and 1.9, respectively) and marijuana dependence (ORs=3.4 and 2.5, respectively) compared with those without anxiety disorder (n=303).

Logistic regression analyses revealed that GAD was associated with a significantly increased risk for having lifetime SUDs (OR=2.34), alcohol dependence (OR=1.73), and marijuana dependence (OR = 3.36), as well as recent marijuana dependence (OR=3.28).

The researchers also found that a history of physical abuse was associated with a significantly increased risk for having lifetime SUDs (OR=1.71) and recent marijuana dependence (OR=3.47), and later treatment with a mood stabilizer was associated with increased risk for having recent SUDs, at 8% per year.

Furthermore, earlier onset of a first episode of mania or hypomania was associated with an increased risk for having lifetime SUDs, at 5% per year, and recent marijuana dependence, at 12% per year.

Gao and team conclude: "Positive associations between GAD, later treatment with a mood stabilizer, and early childhood trauma and history of SUDs suggest that adequate treatment of comorbid anxiety, early treatment with a mood stabilizer, and prevention of childhood trauma may reduce the risk for the development of SUDs in patients with BD."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Mark Cowen

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