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[Correspondence] Bipolar disorder: defining symptoms and comorbidities – Authors’ reply

We appreciate the interest from Alain Dervaux and Xavier Laqueille, and Philip Mitchell in our Seminar on bipolar disorder.1 Substance use disorders are indeed very common in patients with bipolar disorder. Tentative reasons for such frequent comorbidity include a shared genetic diathesis, common neurobiological pathways (ie, dopamine, glutamate), diagnostic overlap, trauma, self-medication (ie, use of psychotropics to improve symptoms or side-effects of drugs), social diathesis (social environment), and substance-induced episodes.