The Significant Presence of Comorbidities in Bipolar Depression: Insights From Mark Zimmerman, MD

CONFERENCE REPORTER

Mark Zimmerman, MD, has several poster presentations at this year’s American Society of Clinical Psychopharmacology Annual Meeting. One of them, “The Complex Diagnostic Profile of Psychiatric Outpatients Presenting for the Treatment of Bipolar Depression,”¹ focused on the challenge of identifying comorbidity in patients with bipolar depression. In particular, Zimmerman noted the lack of studies using semi-structured interviews for bipolar depression in routine clinical practice.

“We asked patients whether or not they wanted treatment for their comorbid disorders, which from a consumer-oriented perspective is rather important,” said Zimmerman.

Zimmerman analyzed 131 patients using the Structured Clinical Interview for DSM-IV and Structured Interview for DSM-IV Personality interviews and found that 80% had comorbid psychiatric disorders (n=104), more than 60% were diagnosed with 2 or more comorbid psychiatric disorders (n=60), and almost half were diagnosed with 3 or more comorbid psychiatric disorders. Crucially, approximately two-thirds of these patients expressed a desire for treatment of their comorbidities, with many having 2 or more conditions. Zimmerman emphasized the significance of comorbidity in bipolar depression treatment, noting that many clinical studies exclude patients with comorbidities,² which may limit the generalizability of treatment efficacy findings to real-world clinical practice. Many patients seek treatment for multiple disorders, and each must be addressed in order to improve patient outcomes. His team has previously discussed this issue, emphasizing the need for studies that include patients with comorbidities to ensure better real-world applicability.

“Comorbidity has a significant presence in individuals presenting for the treatment of bipolar depression, and the reason why this is important is many of the controlled studies looking at the efficacy of medication for bipolar depression exclude patients that have comorbid conditions. So, as we have in the past, we are raising the issue again of the generalizability of treatment studies to patients who are seen in real world clinical practice,” shared Zimmerman.

More than 90% of patients with attention-deficit disorder wanted treatment; oppositely, patients were the least interested in comorbid substance use disorder treatment.

Importantly, patients with 2 or more comorbid disorders were more than 3 times likely to be chronically unemployed.

Dr Zimmerman is the director of the Adult Partial Hospital Program and outpatient psychiatry at Rhode Island and The Miriam hospitals, and a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University.

References

1. Zimmerman M. The complex diagnostic profile of psychiatric outpatients presenting for the treatment of bipolar depression. Poster presented at: 2026 ASCP Annual Meeting; May 26-29; Miami Beach, FL. Accessed March 15, 2016.

2. Wong JJ, Jones N, Timko C, Humphreys K. Exclusion criteria and generalizability in bipolar disorder treatment trials. Contemp Clin Trials Commun. 2018;9:130-134.