Comparison of Antidepressant Use Between Subjects With Bipolar Disorder and Major Depressive Disorder With or Without Comorbid Anxiety
Bibliographic record
Abstract
OBJECTIVE: Antidepressants are recommended for the treatment of depressive and anxiety symptoms in patients with major depressive disorder, but caution is urged when used for the treatment of these symptoms in bipolar disorder. It is not known whether these differing recommendations are reflected in clinical practice, as comparative analyses of rates of antidepressant use between bipolar disorder and major depressive disorder subjects with or without comorbid anxiety have not been reported. METHOD: Data source was the Canadian Community Health Survey on Mental Health and Well-Being, a large, representative mental health survey conducted from May to December 2002. Rates of antidepressant use were compared for subjects with bipolar disorder according to the World Mental Health-Composite International Diagnostic Interview or major depressive disorder according to DSM-IV criteria, with or without comorbid anxiety (DSM-IV). The independent effects of the diagnostic group and of a comorbid anxiety disorder were determined by controlling for sociodemographic and clinical variables using logistic regression. RESULTS: Rate of antidepressant use was significantly higher among all subjects with bipolar disorder (N = 756) compared with all subjects with major depressive disorder (N = 3863) (27.2% vs. 23.1%, p = .02), but this difference was no longer significant when other factors were controlled for in the regression analysis. With the major depressive disorder without anxiety group as the reference, the likelihood of antidepressant use was significantly higher in both the bipolar disorder with anxiety group (OR = 1.83, 95% CI = 1.02 to 3.27, p = .04) and the major depressive disorder with anxiety group (OR = 1.45, 95% CI = 1.00 to 2.09, p = .05). CONCLUSION: After sociodemographic and clinical variables were controlled for, similar rates of antidepressant use were identified among bipolar disorder and major depressive disorder subjects. Further efforts are needed to enhance screening for bipolar disorder among depressed patients and to re-examine the risk/benefit analysis of antidepressants for bipolar disorder patients in light of emerging alternatives. Significantly increased rates of antidepressant use in subjects with a comorbid anxiety disorder suggest that anxiety symptoms may be a key reason why physicians are choosing to prescribe antidepressants for patients with bipolar disorder and major depressive disorder.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".