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Trazodone for sleep bluelight and insomnia was more common in patients with bipolar disorder who received the most frequent or effective doses of tricyclic antidepressant (TCA) (P=0.03 for trend across studies), with no difference between tricyclic antidepressant (TCA) and venlafaxine (VF) at the higher doses used by patients with other diagnoses (P=0.10; Figure 6). When examined by treatment duration, the number of cases in which the patients received less than 12 weeks of tricyclic antidepressant was approximately twice as likely to be among patients with bipolar disorder than among patients with other diagnoses (odds ratio, 2.23; 95% confidence interval, 1.28 to 3.17; P=0.02, and odds ratio, 1.98, 0.99 to 4.22; P=0.01, respectively). FIGURE 6. View largeDownload slide Odds ratios and 95% confidence intervals for the use of treatment insomnia and inattention in patients with bipolar disorder who received treatment with a TCAs or TCA-like antidepressant. FIGURE 6. View largeDownload slide Odds ratios and 95% confidence intervals for the use of treatment insomnia and inattention in patients with bipolar disorder who received treatment with a TCAs or TCA-like antidepressant. DISCUSSION This study examined the effectiveness of atypical antipsychotics as treatments for sleep/wake impairment in patients with bipolar disorder and their co-morbid conditions. Our findings provided evidence that long-term use of an anticonvulsant for sleep/wake impairment in bipolar I patients may be associated with lower rates of insomnia compared with shorter and shorter-acting antipsychotics in patients with bipolar II disorder, and that both a TCAs or TCA-like antidepressant may be associated with a higher rate of nonadherence. Although the overall rates were higher after one or two antidepressant treatments, our finding is consistent with the results of prior studies that showed patients with bipolar I disorder no previous prior treatment, bipolar II disorder and concurrent depression anxiety disorders were less adherent to treatment compared with patients bipolar I disorder, 2 disorder as well Bipolar I and concurrent depression anxiety disorders.28-30 This difference may be explained by the fact that patients on an acute treatment course with antipsychotic may have more difficulty getting to sleep, or that, after one two treatments, the effectiveness or tolerability of drug may fade, in which case the dose might be higher and the adverse effects more pronounced.31 Although the risk of nonadherence may have reduced in patients with bipolar I disorder no prior treatment, the results are consistent with those of other studies that showed similar nonadherence rates.29,30 Our findings, however, may suggest that antipsychotic medication be a risk factor for greater nonadherence in bipolar patients with prior treatment due to a higher risk of adverse events.32-34 In addition, our rates of nonadherence among patients with bipolar I disorder more than Cheapest viagra in uk two comorbid conditions and in patients treated for depression and anxiety disorders with an initial diagnosis of bipolar disorder that was not II were similar to the rates found in previous studies.30,31,35-38 Because nonadherence to antipsychotic medications may result from a higher dose or longer courses of treatment,39-41 additional studies are needed to clarify whether bipolar patients may be more susceptible to the adverse events caused at lower doses or longer courses of treatment. In the current study, compared with nonadherence to an anticonvulsant, the rates of nonadherence were higher in patients with bipolar I disorder concurrent comorbid anxiety disorders, with a particular risk for insomnia. This finding suggests that the higher rates of adverse events associated with bipolar I disorder concurrent comorbid anxiety diagnoses may be attributable.



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