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. 2025 Apr 29;20(4):e0322274.
doi: 10.1371/journal.pone.0322274. eCollection 2025.

The effect of systematic antidepressant treatments in the early stages on sleep and impulsivity in bipolar euthymic patients: A cross-sectional study

Mingjin Wang  1   2 , Xuguang An  1 , Dongyu Han  1 , Xiaofei Hou  1 , Chenghao Yang  1   2
Affiliations

The effect of systematic antidepressant treatments in the early stages on sleep and impulsivity in bipolar euthymic patients: A cross-sectional study

Mingjin Wang et al. PLoS One. .

Abstract

Background and objectives: Due to early misdiagnosis, bipolar patients who had a depressive episode as their initial onset often received systematic antidepressant treatments and continued to suffer from sleep disturbances and elevated impulsivity, even during euthymic state. The study aims to assess the effect of systematic antidepressant treatments in the early stages on sleep and impulsivity in bipolar euthymic patients, and further explore the potential mediating role of sleep in the relationship between early antidepressant uses and impulsivity.

Methods: A total of 124 bipolar euthymic patients were enrolled. Based on the early use of antidepressants, patients were divided into AT group (systematic antidepressant treatment group) and NT group (no systematic antidepressant treatment group). Sleep quality and impulsivity were assessed using Pittsburgh Sleep Quality Index and Barratt Impulsivity Scale Questionnaire version 11, respectively. Statistical analyses were conducted using the t-test, Chi-square test, and Mann-Whitney U test, and mediation analysis was performed using bootstrapping.

Results: Patients in the AT group showed poorer sleep quality and higher impulsivity than those in the NT group. Patients' sleep quality was positively correlated with impulsivity. Sleep quality mediated the relationship between antidepressant uses and impulsivity, including both overall impulsivity and non-planning impulsivity.

Conclusions: This study suggests a correlation between early-stage antidepressant use, sleep quality, and impulsivity of bipolar euthymic patients, highlighting the importance of early diagnosis of bipolar disorder and appropriate antidepressant prescriptions. Furthermore, improving sleep quality would be effective in reducing the risk of impulsive behaviors.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flowchart.
AT, systematic antidepressant treatment; NT, no systematic antidepressant treatment.
Fig 2
Fig 2. The crude mediation model of the association of antidepressant uses and impulsivity through sleep quality.
PSQI, Pittsburgh Sleep Quality Index; p* < 0.05, p*** < 0.001 (two-tailed).
Fig 3
Fig 3. The adjusted mediation model of the association of antidepressant uses and impulsivity through sleep quality.
PSQI, Pittsburgh Sleep Quality Index; adjusting sex, age, years of diagnostic delay and use of mood stabilizers; p* < 0.05, p*** < 0.001 (two-tailed).
See this image and copyright information in PMC

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