Secondary outcomes were hospitalization due to manic or depressive symptoms or any psychiatric hospitalization. 7 The primary outcome was hospitalization due to affective symptoms, based on the Hospital Discharge register. Information on medication use was obtained from the Prescription Register and modeled with PRE2DUP method, which predicts periods of use and non-use. Thiazide diuretics were used as a negative control. The primary exposures were use of CCBs and adenosine modulators. Follow-up started on January 1, 1996, or at the date of diagnosis, and ended at death, diagnosis of schizophrenia, or on Decem(whichever occurred first). They identified individuals diagnosed with bipolar disorder between 19 from inpatient, specialized outpatient, sickness absence, and disability pension registers. Lintunen and colleagues 6 investigated the risk of psychiatric hospitalization associated with CCBs (dihydropyridines, verapamil, diltiazem) and adenosine modulators (allopurinol, dipyridamole) in a nationwide Finnish cohort of individuals with bipolar disorder. 4 Dipyridamole is an antithrombotic and vasodilator that inhibits adenosine reuptake. 4 Allopurinol is a xanthine oxidase inhibitor used to treat gout and hyperuricemia. Allopurinol and dipyridamole are adenosine modulators that may have potential in the treatment of bipolar disorder and other severe mental illnesses. Previous reviews include the adenosine modulator allopurinol 2 and calcium-channel blockers (CCBs) 3 for potential repurposing in bipolar disorder, although evidence for the latter has been inconclusive. 1 One approach to identifying novel treatments is drug repurposing, whereby a drug approved for 1 disease is investigated for its potential for a new indication. Inadequate response and treatment resistance remain issues in bipolar disorder. His blood pressure control subsequently improved, without any change in his psychiatric symptoms. He does not have a primary care physician, so his psychiatrist started him on amlodipine, which was titrated to 10 mg daily. Mr Amir was diagnosed with comorbid hypertension after multiple elevated readings at his outpatient psychiatry visits. He has been on a stable psychotropic regimen of quetiapine 100 mg in the morning and 400 mg at bedtime, and valproic acid 750 mg daily. He also has episodic irritability and anger. He has chronic insomnia, low energy, impaired concentration, and suspiciousness. He was last hospitalized for affective symptoms at age 35. “Mr Amir” is a 48-year-old male from the Balkans with a 17-year history of bipolar I disorder with psychotic features.
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