Bipolar Disorder

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Although face validity would suggest that stabilizing mania or hypomania in patients with bipolar disorder would improve impulse control and judgment, and therefore lead to decreases in substance use, the literature is thin regarding the efficacy of mood stabilizing medications on bipolar and SUD outcomes. An open pilot trial by Gawin and Kleber (1984) suggested that lithium may be effective in reducing cocaine use in patients with cyclothymia and cocaine abuse. However, an open trial of lithium in patients with bipolar spectrum disorders and cocaine abuse (Nunes, McGrath, Wager, & Quitkin, 1990) demon strated little efficacy in mood or cocaine outcome measures. An open label trial with valproate in patients with bipolar disorder and SUD (Brady, Sonne, Anton, & Ballenger, 1995) resulted in improvement in mood and substance use measures. Additionally, open-label trials of lamotrigine (Brown, Nejtek, Perantie, Orsulak, & Bobadilla, 2003) and quetiapine (Brown, Nejtek, Perantie, & Bobadilla, 2002) in patients with bipolar disorder and cocaine dependence suggest that these medications may be associated with improved mood symptoms and cocaine craving, although not with significant reductions in cocaine use. Since there have been no double-blind, placebo-controlled studies assessing the efficacy of mood stabilizers or antipsychotic medications in adults with bipolar disorder and SUDs, the results of these open trials can be seen as preliminary at best. However a double-blind, placebo-controlled, 6-week trial of lithium in adolescents with bipolar disorder and substance dependence (Geller et al., 1998) found lithium to be efficacious for outcomes in both disorders.

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