Adjunctive Antidepressant Use in Bipolar Disorder and Its Clinical Correlates: An Asian Psychotropic Prescription Patterns Consortium Study

Introduction: Adjunctive antidepressant (AD) use is prevalent for the treatment of bipolar disorder (BD) in many countries, but there is little information about this practice in Asia. Accordingly, we addressed the prevalence, dosing, and clinical correlates of adjunctive AD use with BD in a large Asian sample. Methods: Patients with BD were recruited across 13 Asian sites (PR China, Hong Kong, India, Indonesia, Japan, South Korea, Malaysia, Myanmar, Pakistan, Singapore, Sri Lanka, Taiwan, and Thailand) for this cross-sectional study. We examined differences between patients with versus without adjunctive AD treatment. Multivariable logistic regression was used to identify factors associated with the use of adjunctive AD. Results: Among a total of 2114 adult participants (47.7% men; age 42.4 years [CI: 41.8–43.0]; BMI 25.0 kg/m² [24.8–25.2]), the prevalence of AD use averaged 19.8% [18.1–21.6], at a mean imipramine-equivalent dose of 113 [110–116] mg/day. Adjunctive AD use was associated with factors including older age, outpatient status, more depression, suicidal behavior, rapid cycling, and lower doses of MS and antipsychotics (APs). Discussion: Usage of AD treatment for BD in Asia was less than half that reported in Western samples. Such use of AD treatment appeared to be well tolerated but underscores the need for close clinical follow-up to avoid risks of excessive elevation of mood or behavior.