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

## TL;DR

This study finds that early antidepressant use in bipolar patients is linked to worse sleep and higher impulsivity, even when they are symptom-free.

## Contribution

The study reveals that sleep quality mediates the relationship between early antidepressant use and impulsivity in euthymic bipolar patients.

## Key findings

- Patients with early antidepressant treatment had poorer sleep quality and higher impulsivity.
- Sleep quality was positively correlated with impulsivity in bipolar patients.
- Sleep quality partially mediates the effect of antidepressant use on impulsivity.

## Abstract

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.

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.

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.

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.