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Substance Use Disorders (SUD) Substance use interferes with treatment adherence, treatment response, and worsens illness outcomes in BD.[213] Bipolar spectrum disorders are common among SUDs, and often go unrecognized.[214,215] Management for BD and SUD may be initiated simultaneously, especially when withdrawal from substance use is deemed to contribute to mood instability.[216,217] The sparse available literature is summarized here.[213,216,217] For alcohol use disorder comorbid with BD, a randomized trial found that the combination of lithium and divalproex was more effective than lithium alone in reducing drinking frequency

Pregnant or Breastfeeding Individuals: Treatment is not available for individuals who are pregnant, breastfeeding, or may be pregnant

The risk for hypoglycemia is higher for people on other medications to manage blood sugar like insulin or sulfonylureas

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