A cross-sectional study on the impact of early systematic antidepressant therapy on positive/negative affect and impulsivity in euthymic bipolar disorder patients

BACKGROUND AND OBJECTIVES: Due to an initial misdiagnosis, bipolar patients who experienced a depressive episode as their first onset were often treated with antidepressants, and continued to exhibit sleep disturbances and elevated impulsivity, even during periods of euthymia. The study aims to assess the effect of systematic antidepressant treatments in the early stages on impulsivity and positive/negative affect in patients with bipolar euthymic disorder. Additionally, it explores the potential mediating effects of positive/negative affect on the relationship between antidepressant uses and impulsivity. METHODS: A cross-sectional study was conducted involving 124 Han Chinese patients with bipolar disorder (BD), who were equally divided into two groups based on a history of systematic antidepressant treatments in the early stages: the systematic antidepressant treatment (AT) group and the no antidepressant treatment (NT) group. Participants were assessed using the Positive and Negative Affect Scale and the Barratt Impulsiveness Scale. Statistical analyses included Chi-square tests, t-tests, Mann-Whitney U tests, and mediation analysis using bootstrapping. RESULTS: Patients in the AT group exhibited significantly higher levels of negative affect (p = 0.017), attentional impulsivity (p = 0.035), non-planning impulsivity (p = 0.010), and total impulsivity (p = 0.011) compared to those in the NT group. No significant differences were found in positive affect or motor impulsivity between the two groups. There was a significant inverse correlation between negative affect and motor impulsivity (p < 0.01). Mediation analysis indicated that negative affect did not play a significant mediating role between systematic antidepressant treatments and impulsivity. CONCLUSIONS: Systematic antidepressant treatment in the early stages is associated with increased negative affect and impulsivity during bipolar euthymia. These findings highlight the importance of cautious antidepressant prescription and the need for early diagnosis and personalized treatment strategies for BD patients. Longitudinal research is warranted to further elucidate the relationships between antidepressant use, affect state and impulsivity.