Frequency of stimulant treatment and of stimulant-associated mania/hypomania in bipolar disorder patients.

OBJECTIVE: Stimulants have been used to treat ADHD or augment bipolar depression treatment in patients with bipolar disorder (BD). However, the effects of stimulant treatment in BD patients have been insufficiently studied. To date, this is the largest study on amphetamine/ methylphenidate treatment and associated mania/hypomania in BD patients.
METHOD: Charts of patients evaluated at the Emory Bipolar Disorder Specialty Clinic from 7/05 to 10/07 and diagnosed with BD were randomly reviewed. Past diagnostic and treatment information were obtained from patient reports and collateral information. Bipolar diagnosis and past stimulant-associated mania were assessed by a board-certified psychiatrist using Structured Clinical Diagnostic Interview. Methylphenidate, amphetamine, and modafinil were considered stimulants. Multivariate regression models were used to identify predictors of receiving stimulant treatment and of experiencing stimulant-associated mania.
RESULTS: Of the 137 adult BD patients (72% BDI; 28% BDII/ NOS), 25% had prior stimulant treatment for ADHD or bipolar depression. Among those with prior stimulant treatment (21 with methylphenidate, 17 with amphetamine, and 6 with modafinil), 43% were treated with a concurrent mood stabilizer, and some with different types of stimulants sequentially. The rate of stimulant-associated mania/hypomania was 40%. Having axis-I comorbidity, absence of past substance addiction, and currently being unemployed were three factors significantly associated with prior stimulant treatment. After adjusting for important clinical variables, absence of axis-I comorbidity was associated with stimulant-associated mania.
CONCLUSIONS: BD patients commonly receive stimulant treatment and often experience stimulant-associated mania/hypomania. More studies are needed to examine the safety and efficacy of stimulant treatment in BD patients.