Treating Bipolar Disorder as a Comorbidity of SUD

Comorbidities such as bipolar disorder, depression, or anxiety occurring in patients with substance use disorder (SUD) can be common. How do clinicians approach this treatment? What should be prioritized? Following her Psych Congress 2022 session "The State of Substance Use: Current Trends," Arwen Podesta, MD, psychiatrist at Podesta Wellness, New Orleans, Louisiana, discussed treating comorbidities in SUD and what strategies are available to clinicians and their patients.

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Arwen Podesta, MD, ABPN, FASAM, ABIHM, is a board-certified adult psychiatrist with sub-specializations in addiction medicine, forensic psychiatry, and integrative medicine. A graduate of the University of Southern California Keck School of Medicine, Dr Podesta completed her psychiatry residency in at Louisiana State University before pursuing a fellowship in forensic psychiatry at Tulane University.

In the aftermath of Hurricane Katrina, Dr Podesta became involved in actioning psychiatric care for underserved and disenfranchised populations and was awarded the Gambit’s 40 Under 40 in 2009. Since then she has been an enthusiastic participant in the public sector as medical director of multiple addiction treatment centers, and a consultant for the Orleans Criminal Court, Drug Court and Re-entry Services. Additionally, she maintains status as a consulting addiction medicine specialist and an expert witness. 

Read the transcript:

Psych Congress Network: What are some of the significant comorbidities of addiction, how should clinicians approach their treatment plans, and what should they prioritize?

Dr Podesta: That's such a good question. Substance use disorder and substance issues have a lot of comorbidities. A lot of the part of the brain that's the reward system is hijacked. That can cause things like depression, anxiety, even unleash some bipolar. The drug itself can tip people into bipolar type of symptoms or even into psychotic symptoms that may or may not be related to underlying schizophrenia. There are so many questions about that. Also, attentional disorders and memory impairment, all of those are certainly very comorbid with substance use disorders.

We have to think about what the underlying substance is. Is it something like an upper that might tip someone into psychosis and cause a temporary psychosis? Or, as Dr Wylands earlier today was talking about, is it marijuana-induced psychosis or even a K2 or spice, a synthetic marijuana-induced psychosis perhaps? We have to really think about what the cause is, what the comorbidity is, and it's a chicken and egg phenomenon. However, oftentimes they are 2 comorbid factors and sets of issues and we still have to treat both. Clinicians have to think about how to treat the symptoms at hand, substance use disorder, and decrease or stop the substance. If there's psychosis or depression or anxiety or attentional disorders or sleep disorders, which is very common, then we need to treat that, too. We can treat it with all different methodologies, from pharmacology to therapies such as pharmacotherapy, behavioral therapies, peer supports, lifestyle changes. We can treat it.