Associations between early antidepressant exposure, affective states, and subjective sleep quality among euthymic depressive-onset bipolar patients: a cross-sectional parallel mediation analysis

Bipolar Disorder (BD) is often misdiagnosed as major depressive disorder, leading to prolonged antidepressant use during the early stages. Antidepressant treatment has shown significant effects on affective states and sleep. However, the relationship between early antidepressant use, affective states, and sleep quality has yet to be explored in the BD population.

A cross-sectional, single-blind study was conducted in Tianjin Anding Hospital between 1st September 2020 and 30th May 2023. BD patients were categorized into antidepressant treatment (AT) and non-antidepressant treatment (NT) groups based on whether they received early-stage systematic antidepressant treatment. Affective states and subjective sleep quality were measured using the Positive and Negative Affect Schedule (PANAS) and Pittsburgh Sleep Quality Index (PSQI), respectively.

Spearman’s correlation examined associations among antidepressant use, affective states, and sleep; mediation effects of affective states were analyzed using a bootstrap method. A total of 124 participants were included. Descriptive statistics showed that the AT group had higher PSQI scores than the NT group (Z = − 5.414, p