20-Year Trends in the Pharmacologic Treatment of Bipolar Disorder by Psychiatrists in Outpatient Care Settings

Rhee, Taeho Greg; Olfson, Mark; Nierenberg, Andrew A.; Wilkinson, Samuel T.

doi:10.1176/appi.ajp.2020.19091000

Cited by 156 publications

(171 citation statements)

References 46 publications

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“…It also revealed that the prescription rate of lithium carbonate, which is the first-choice drug for bipolar disorder [ 11 ], is only approximately 20% and is decreasing each year [ 11 ]. This trend was also consistent with the longitudinal data analysis results obtained from the National Ambulatory Medical Care Surveys [ 12 ]. In a study using Swedish national registries, 70% of patients with bipolar disorder were prescribed antidepressants [ 13 ].…”

Section: Introductionsupporting

confidence: 90%

“…In a study using Swedish national registries, 70% of patients with bipolar disorder were prescribed antidepressants [ 13 ]. In the United States, antidepressants are prescribed to 57.5% of patients with bipolar disorder [ 12 ]. In a study of nationwide and population-based prescription patterns in the Danish population, 59.12% of patients with bipolar disorder were prescribed antidepressants [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Real-world clinical features of and antidepressant prescribing patterns for outpatients with bipolar disorder

Tokumitsu

Yasui‐Furukori

Adachi³

et al. 2020

BMC Psychiatry

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Background Several evidence-based practice guidelines have been developed to better treat bipolar disorder. However, the articles cited in these guidelines were not sufficiently based on real-world clinical practice. Methods The MUlticenter treatment SUrvey on BIpolar disorder in Japanese psychiatric clinics (MUSUBI) is a study conducted to accumulate evidence on the real-world practical treatment of bipolar disorder. Psychiatrists were asked to complete a questionnaire about patients with bipolar disorder by performing a retrospective medical record survey. The questionnaire included patient characteristics (age, gender, height, weight, academic background, and occupational status), comorbidities, mental status, treatment period, Global Assessment of Functioning (GAF) score, and details of pharmacological treatment. Results Data on 2705 patients were included in this study. The proportion of patients receiving antidepressant prescriptions was 40.9%. The most commonly used antidepressant was duloxetine, and the most frequently used antidepressant class was selective serotonin reuptake inhibitors (SSRIs). Binomial logistic regression analysis and bivariate analysis revealed that the usage of antidepressants was correlated with low prescription rates for mood stabilizers, high prescription rates for anxiolytics and hypnotics, and low GAF scores. In addition, patients in a depressive state had a significantly higher rate of antidepressant prescriptions than patients with other mental states. Conclusions Approximately 40% of patients in Japan with a diagnosis of bipolar disorder have received antidepressants. Antidepressants were most often prescribed in combination with mood stabilizers, antipsychotics or both. Patients who were prescribed antidepressants received fewer mood stabilizers, more anxiolytics, and more hypnotics than those who did not receive antidepressant prescriptions.

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Section: Introductionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Real-world clinical features of and antidepressant prescribing patterns for outpatients with bipolar disorder

Tokumitsu

Yasui‐Furukori

Adachi³

et al. 2020

BMC Psychiatry

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“…The pharmacological treatment of bipolar disorder has changed over the last several decades. Two major changes were a large increase in prescriptions of atypical antipsychotics [1][2][3][4][5][6] and routine prescribing of 2 or more psychiatric drugs, or polypharmacy [3,5,[7][8][9]. The increase in prescriptions of atypical antipsychotics occurred in parallel with a decline in prescriptions of lithium [2,10,11], the traditional gold standard for maintenance treatment for bipolar disorder [12,13].…”

Section: Introductionmentioning

confidence: 99%

Association between Adherence with an Atypical Antipsychotic and with Other Psychiatric Drugs in Patients with Bipolar Disorder

Bauer

Glenn²,

Alda

et al. 2020

Pharmacopsychiatry

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Background Using U.S. pharmacy and medical claims, medication adherence patterns of patients with serious mental illness suggest that adherence to atypical antipsychotics may be related to adherence to other prescription drugs. This study investigated whether adherence to an atypical antipsychotic was related to adherence to other prescribed psychiatric drugs using self-reported data from patients with bipolar disorder. Methods Daily self-reported medication data were available from 123 patients with a diagnosis of bipolar disorder receiving treatment as usual who took at least 1 atypical antipsychotic over a 12-week period. Patients took a mean of 4.0±1.7 psychiatric drugs including the antipsychotic. The adherence rate for the atypical antipsychotic was compared to that for other psychiatric drugs to determine if the adherence rate for the atypical antipsychotic differed from that of the other psychiatric drug by at least ±10%. Results Of the 123 patients, 58 (47.2%) had an adherence rate for the atypical antipsychotic that differed from the adherence rate for at least 1 other psychiatric drug by at least±10%, and 65 (52.8%) patients had no difference in adherence rates. The patients with a difference took a larger total number of psychiatric drugs (p<0.001), had a larger daily pill burden (p=0.020) and a lower adherence rate with the atypical antipsychotic (p=0.007), and were more likely to take an antianxiety drug (p<0.001). Conclusion Adherence with an atypical antipsychotic was not useful for estimating adherence to other psychiatric drugs in about half of the patients with bipolar disorder.

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“…Despite the undeniable evidence in favour of its application in BD, a descendent tendency in the use of lithium has been noticed in the US (Rhee et al, 2020) and in numerous European countries (Bohlken et al ., 2020;Karanti et al, 2016;Kessing et al, 2016;Lyall et al, 2019). In several of them it has changed from being the most prescribed drug to the least one, even behind the controversial antidepressants.…”

Section: Introductionmentioning

confidence: 99%

“…In fact, over the last two decades, the decrease in lithium´s use is not widespread and in certain countries the lithium´s prescription rate has remained high. In some countries, more than 50% of bipolar patients are treated with lithium while in the US for example, only the 17% (Kessing et al, 2019;Parabiaghi et al, 2015;Renes et al, 2018, Rhee et al, 2020 (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Overview of Lithium´s Use: A Nationwide Survey

Mendiola

Hidalgo‐Mazzei

Vieta

et al. 2020

Preprint

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Background: Lithium is considered the gold standard treatment for bipolar disorder (BD). Its use as a first-line treatment in BD is supported by current clinical guidelines and scientific evidence. However, over the last two decades it has been observed a downward tendency in lithium´s use in several developed countries. Based on a nationwide survey, the objective of this study is to analyze in a large sample of psychiatrists relevant issues of the use of lithium salts in BD.Methods: Data were collected through an anonymous survey sent by email among 500 psychiatrists who belong to a National Society of Psychiatry (Spanish Society of Biological Psychiatry). The survey is a self-administered questionnaire consisting of 21 items on the most key aspects of the use of lithium (indication, dosage, monitoring and information for patients).Results: 212 psychiatrists completed the survey. 70% of psychiatrists prescribe lithium to more than 50% of patients diagnosed with BD. Adverse effects are the main reason not to use lithium salts. Over 75% of the participants consider lithium salts the treatment of choice for the maintenance phase of BD, both in women and men. Most of the participants (> 50%) start lithium after the first affective episode, use conservative plasma concentrations (0.6-0.8 mmol/L) and generally prescribe it twice a day. 57% of psychiatrists who treat patients under 18 do not use lithium in this population. About 70% of the survey respondents use official protocols to inform and monitor patients who are on lithium treatment.Conclusions: From the results of the present study it can be concluded that the use of lithium in Spain is in line with the recommendations of the main international clinical guidelines and current scientific literature. The first reason not to prescribe lithium in our country is the perception of its adverse effects and not the aspects related to its practical use or its effectiveness. Considering that BD is a chronic disease that has a typical onset in adolescence, the reasons for the low rate of prescription of lithium salts in patients under 18 must be thoroughly studied.

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20-Year Trends in the Pharmacologic Treatment of Bipolar Disorder by Psychiatrists in Outpatient Care Settings

Cited by 156 publications

References 46 publications

Real-world clinical features of and antidepressant prescribing patterns for outpatients with bipolar disorder

Real-world clinical features of and antidepressant prescribing patterns for outpatients with bipolar disorder

Association between Adherence with an Atypical Antipsychotic and with Other Psychiatric Drugs in Patients with Bipolar Disorder

Overview of Lithium´s Use: A Nationwide Survey

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