- Comorbid anxiety plus SUD associated with greater clinical severity, including higher ADHD, PTSD, rapid cycling, obesity, and unemployment rates.
- Marked regional prescribing differences: higher AX and SUD prevalence in North America; more antidepressant use in Europe and Pacific; benzodiazepines frequent in SUD.
- Heterogeneity in BD treatment highlights need for context specific guidelines and research on medication assisted SUD interventions to improve individualised care.
Bipolar Disord. 2026 Sep;28(6):e70167. doi: 10.1111/bdi.70167.
ABSTRACT
OBJECTIVES: To investigate pharmacological treatment patterns in individuals with bipolar disorder (BD) with and without comorbid substance use disorder (SUD) and anxiety disorder (AX), we leveraged the Global Bipolar Cohort to analyze cross-regional practices across North America, Europe, and the Pacific.
METHODS: Fourteen cohorts contributed aggregate data on pharmacotherapy, demographics, diagnostic subtypes, and comorbidities. Proportional meta-analyses using generalized linear mixed models were conducted to examine prescription trends and identify clinical differences.
RESULTS: The sample (N = 11,521) was 60% female and 84% Caucasian. Participants were categorized into four mutually exclusive groups based on comorbidity status: those with comorbid AX only, comorbid SUD only, both AX and SUD, or neither. The AX+SUD subgroup showed higher rates of attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), rapid cycling, obesity, and unemployment, reflecting a more severe clinical profile. Regional variations were notable: North American cohorts reported higher prevalence of AX and SUD than European and Pacific cohorts. Antidepressants use for AX were more common in Europe and the Pacific, while North American prescribing patterns were more variable. Benzodiazepine use was high among individuals with SUD across all regions. Lithium and first-generation antipsychotic prescriptions varied, with higher rates observed in Europe.
CONCLUSIONS: Findings underscore the heterogeneity of BD and the influence of comorbid AX and SUD on illness burden and treatment. Regional prescribing variations underscore the need for context-specific guidelines. Gaps in data on medication-assisted treatment for SUD point to areas for future research. These insights can support more individualized and effective care for complex BD presentations.
PMID:42578538 | DOI:10.1111/bdi.70167
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