Pharmacotherapy in Comorbid Bipolar Disorder and Post-Traumatic Stress Disorder From the STEP-BD Cohort

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders Pub Date : 2025-02-14 DOI:10.1111/bdi.70002

Samantha E. Russell, Anna L. Wrobel, David R. Skvarc, Mojtaba Lotfaliany, Olivia M. Dean, Melanie M. Ashton, Pedro V. S. Magalhães, Andrew Nierenberg, Michael Berk, Alyna Turner

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Abstract

Introduction

Post-traumatic stress disorder (PTSD) is more prevalent in those with bipolar disorder (BD) than in the general population, with rates of PTSD as high as 55% in some BD cohorts. Despite this, little research explores the effects of pharmacotherapy treatments in those with comorbid BD and PTSD. This study aims to explore patterns of pharmacotherapy use at baseline and their impact on symptoms in individuals with BD alone and comorbid BD and PTSD.

Methods

The Systematic Treatment Enhancement Program for BD (STEP-BD) cohort was utilised to examine and compare BD symptoms and pharmacotherapy treatments between those with BD alone (n = 3393) and those with comorbid BD and PTSD (n = 304). We conducted regression models to compare those with and without comorbid PTSD. Models included measures of depression, mania, functioning and quality of life over 24 months of the STEP-BD study. We included baseline pharmacotherapies (lithium, valproate, antidepressants, antipsychotics and benzodiazepines) as predictor outcome variables in all models.

Results

At baseline, reported use of lithium was lower in the comorbid BD and PTSD group, while the use of antidepressants, antipsychotics and benzodiazepines was significantly higher in the comorbid BD and PTSD than in the BD alone group. Benzodiazepine use was associated with a small improvement in depression symptom scores and poorer quality of life in those with comorbid BD and PTSD. Lastly, those with comorbid PTSD experienced higher levels of mania and depression symptoms and lower functioning and quality of life compared to BD alone, irrespective of pharmacotherapy treatment.

Conclusion

Clinical trial participants with BD and PTSD reported worse symptoms and outcomes across 24 months of the STEP-BD study compared to those without comorbid PTSD, regardless of baseline medication use. These results highlight the importance of considering comorbidity in the treatment of mental health conditions, specifically BD, and the need for further exploration of effective treatment options.

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STEP-BD队列中共病双相情感障碍和创伤后应激障碍的药物治疗。

简介：创伤后应激障碍（PTSD）在双相情感障碍（BD）患者中比在一般人群中更为普遍，在一些双相情感障碍队列中PTSD的发病率高达55%。尽管如此，很少有研究探讨药物治疗对双相障碍和创伤后应激障碍患者的影响。本研究旨在探讨基线时药物治疗的使用模式及其对双相障碍和双相障碍合并PTSD患者症状的影响。方法：采用双相障碍系统治疗增强计划（STEP-BD）队列研究，比较单独双相障碍患者（n = 3393）和双相障碍合并PTSD患者（n = 304）的双相障碍症状和药物治疗效果。我们采用回归模型来比较合并和不合并PTSD的患者。模型包括在STEP-BD研究中超过24个月的抑郁、躁狂、功能和生活质量的测量。我们将基线药物治疗（锂、丙戊酸盐、抗抑郁药、抗精神病药和苯二氮卓类药物）作为所有模型的预测结果变量。结果：基线时，报告的双相障碍和PTSD合并症组锂的使用较低，而双相障碍和PTSD合并症组抗抑郁药、抗精神病药和苯二氮卓类药物的使用明显高于单独双相障碍组。苯二氮卓类药物的使用与双相障碍和创伤后应激障碍共病患者抑郁症状评分的小幅改善和较差的生活质量有关。最后，与单独的双相障碍相比，合并PTSD的患者经历了更高水平的躁狂和抑郁症状，以及更低的功能和生活质量，无论药物治疗如何。结论：在24个月的STEP-BD研究中，与没有合并PTSD的患者相比，双相障碍和PTSD的临床试验参与者报告的症状和结果更差，无论基线药物使用情况如何。这些结果强调了在治疗精神健康状况，特别是双相障碍时考虑合并症的重要性，以及进一步探索有效治疗方案的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bipolar Disorders 医学-精神病学

CiteScore

8.20

自引率

7.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Bipolar Disorders is an international journal that publishes all research of relevance for the basic mechanisms, clinical aspects, or treatment of bipolar disorders and related illnesses. It intends to provide a single international outlet for new research in this area and covers research in the following areas: biochemistry physiology neuropsychopharmacology neuroanatomy neuropathology genetics brain imaging epidemiology phenomenology clinical aspects and therapeutics of bipolar disorders Bipolar Disorders also contains papers that form the development of new therapeutic strategies for these disorders as well as papers on the topics of schizoaffective disorders, and depressive disorders as these can be cyclic disorders with areas of overlap with bipolar disorders. The journal will consider for publication submissions within the domain of: Perspectives, Research Articles, Correspondence, Clinical Corner, and Reflections. Within these there are a number of types of articles: invited editorials, debates, review articles, original articles, commentaries, letters to the editors, clinical conundrums, clinical curiosities, clinical care, and musings.