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Multicenter Study
. 2025 Jun;17(2):e70004.
doi: 10.1111/appy.70004.

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

Yi Hu  1 , Qian Hui Chew  2 , Shih-Ku Lin  3   4 , Wen-Chen Ouyang  5   6   7 , Chih-Ken Chen  8 , Seon-Cheol Park  9   10 , Ok-Jin Jang  11 , Kok-Yoon Chee  12 , Kwong Sen Ding  13 , Jamaline Chong  14 , Ling Zhang  15 , Keqing Li  16 , Xiaomin Zhu  17 , Chonnakarn Jatchavala  18 , Pornjira Pariwatcharakul  19 , Roy A Kallivayalil  20 , Sandeep Grover  21 , Ajit Avasthi  21 , Moin Ansari  22 , Margarita M Maramis  23 , Phyo Aung Paing  24 , Chay Hoon Tan  25 , Yu-Tao Xiang  26   27   28 , Mian-Yoon Chong  29 , Yong Chon Park  30 , Takahiro A Kato  31 , Naotaka Shinfuku  32 , Ross J Baldessarini  33   34 , Kang Sim  35
Affiliations
Multicenter Study

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

Yi Hu et al. Asia Pac Psychiatry. 2025 Jun.

Abstract

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.

Keywords: Asia; antidepressants; bipolar disorder; doses; prescription rates.

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