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Is the association of alcohol use disorders with major depressive disorder a consequence of undiagnosed bipolar-II disorder?


Angst, J; Gamma, A; Endrass, J; Rössler, W; Ajdacic-Gross, V; Eich, D; Herrell, R; Merikangas, K R (2006). Is the association of alcohol use disorders with major depressive disorder a consequence of undiagnosed bipolar-II disorder? European Archives of Psychiatry and Clinical Neuroscience, 256(7):452-457.

Abstract

BACKGROUND: There is emerging evidence that there is a spectrum of expression of bipolar disorder. This paper uses the well-established patterns of comorbidity of mood and alcohol use disorder to test the hypothesis that application of an expanded concept of bipolar-II (BP-II) disorder might largely explain the association of alcohol use disorders (AUD) with major depressive disorder (MDD). METHOD: Data from the Zurich study, a community cohort assessed over 6 waves from ages 20/21 to 40/41, were used to investigate the comorbidity between mood disorders and AUD. Systematic diagnostic criteria were used for alcohol abuse, alcohol dependence, MDD, and BP-II. In addition to DSM criteria, two increasingly broad definitions of BP-II were employed. RESULTS: There was substantially greater comorbidity for the BP-II compared to major depression and for alcohol dependence compared to alcohol abuse. The broadest concept of BP-II explained two thirds of all cases of comorbidity of AUD with major depressive episodes (MDE). In fact, the broader the definition of BP-II applied, the smaller was the association of AUD with MDD, up to non-significance. In the majority of cases, the onset of bipolar manifestations preceded that of drinking problems by at least 5 years. CONCLUSIONS: The findings that the comorbidity of mood disorders with AUD was primarily attributable to BP-II rather than MDD and that bipolar symptoms usually preceded alcohol problems may encourage new approaches to prevention and treatment of AUD.

Abstract

BACKGROUND: There is emerging evidence that there is a spectrum of expression of bipolar disorder. This paper uses the well-established patterns of comorbidity of mood and alcohol use disorder to test the hypothesis that application of an expanded concept of bipolar-II (BP-II) disorder might largely explain the association of alcohol use disorders (AUD) with major depressive disorder (MDD). METHOD: Data from the Zurich study, a community cohort assessed over 6 waves from ages 20/21 to 40/41, were used to investigate the comorbidity between mood disorders and AUD. Systematic diagnostic criteria were used for alcohol abuse, alcohol dependence, MDD, and BP-II. In addition to DSM criteria, two increasingly broad definitions of BP-II were employed. RESULTS: There was substantially greater comorbidity for the BP-II compared to major depression and for alcohol dependence compared to alcohol abuse. The broadest concept of BP-II explained two thirds of all cases of comorbidity of AUD with major depressive episodes (MDE). In fact, the broader the definition of BP-II applied, the smaller was the association of AUD with MDD, up to non-significance. In the majority of cases, the onset of bipolar manifestations preceded that of drinking problems by at least 5 years. CONCLUSIONS: The findings that the comorbidity of mood disorders with AUD was primarily attributable to BP-II rather than MDD and that bipolar symptoms usually preceded alcohol problems may encourage new approaches to prevention and treatment of AUD.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Clinic for Clinical and Social Psychiatry Zurich West (former)
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Adult - Alcoholism/complications/epidemiology/psychology - Bipolar Disorder/complications/epidemiology/psychology - Cohort Studies - Depressive Disorder - Major/complications/epidemiology/psychology - Female - Humans - Male - Psychiatric Status Rating Scales - Sex Characteristics - Switzerland/epidemiology
Language:English
Date:2006
Deposited On:29 Sep 2011 08:43
Last Modified:05 Apr 2016 15:01
Publisher:Springer
ISSN:0940-1334
Publisher DOI:https://doi.org/10.1007/s00406-006-0673-3
PubMed ID:16917682

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