Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar I or II disorder: results from the Bipolar CHOICE trial.

Author(s): Bobo WV(1), Reilly-Harrington NA(2), Ketter TA(3), Brody BD(4), Kinrys G(2), Kemp DE(5), Shelton RC(6), McElroy SL(7), Sylvia LG(2), Kocsis JH(4), McInnis MG(8), Friedman ES(9), Singh V(10), Tohen M(11), Bowden CL(10), Deckersbach T(2), Calabrese JR(5), Thase ME(12), Nierenberg AA(2), Rabideau DJ(2), Schoenfeld DA(2), Faraone SV(13), Kamali M(8).

Affiliation(s): Author information: (1)Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. Electronic address: bobo.william@mayo.edu. (2)The Massachusetts General Hospital, Boston, MA, USA. (3)Stanford University School of Medicine, Stanford, CA, USA. (4)Weill Cornell Medical College of Cornell University, New York, NY, USA. (5)Case Western Reserve University School of Medicine, Cleveland, OH, USA. (6)University of Alabama-Birmingham School of Medicine, Birmingham, AL, USA. (7)Lindner Center for HOPE, University of Cincinnati College of Medicine, Cincinnati, OH, USA. (8)University of Michigan School of Medicine, Ann Arbor, MI, USA. (9)University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. (10)University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. (11)University of New Mexico Health Sciences Center, Albuquerque, NM, USA. (12)Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. (13)Upstate Medical University, State University of New York, Syracuse, NY, USA.

Publication date & source: 2014, J Affect Disord. , 161:30-5

BACKGROUND: Little is known about the longer-term effects of adjunctive benzodiazepines on symptom response during treatment in patients with bipolar disorders. METHODS: The study sample consisted of 482 patients with bipolar I or II disorder enrolled in a 6-month, randomized, multi-site comparison of lithium- and quetiapine-based treatment. Changes in clinical measures (BISS total and subscales, CGI-BP, and CGI-Efficacy Index) were compared between participants who did and did not receive benzodiazepine treatment at baseline or during follow-up. Selected outcomes were also compared between patients who did and did not initiate benzodiazepines during follow-up using stabilized inverse probability weighted analyses. RESULTS: Significant improvement in all outcome measures occurred within each benzodiazepine exposure group. Benzodiazepine users (at baseline or during follow-up) experienced significantly less improvement in BISS total, BISS irritability, and CGI-BP scores than did benzodiazepine non-users. There were no significant differences in these measures between patients who did and did not initiate benzodiazepines during follow-up in the weighted analyses. There was no significant effect of benzodiazepine use on any outcome measure in patients with comorbid anxiety or substance use disorders. LIMITATIONS: This is a secondary analysis of data from a randomized effectiveness trial that was not designed to address differential treatment response according to benzodiazepine use. CONCLUSIONS: Adjunctive benzodiazepines may not significantly affect clinical outcome in lithium- or quetiapine-treated patients with bipolar I or II disorder over 6 months, after controlling for potential confounding factors.