Current prescription pattern of maintenance treatments for bipolar patients in Korea: A focus on the transition from acute treatments

Song, Hoo Rim; Kwon, Young Joon; Bahk, Won‐Myong; Woo, Young Sup; Lee, Hwang-Bin; Lee, Jong-Hun; Lee, Dae-Bo; Lee, Sangyeol; Kim, Moon-Doo; Won, Seunghee; Lee, Kwang-Hun; Sohn, InKi; Lee, Jung Goo; Shin, Young June; Chung, Sang-Keun; Jang, Sae-Heon; Jae, Young Myo; Yoon, Bo-Hyun

doi:10.1111/pcn.12337

Cited by 10 publications

(11 citation statements)

References 24 publications

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“…Initially, 43 articles were screened for eligibility, of which 33 were excluded for the following reasons: 11 were excluded because they were review articles, 10,30–39 9 because they were case reports/series, 9,12,14,18,40–44 11 which did not compare changes in disease severity after bupropion treatment or differences in the treatment effect or drop-out or phase-shifting rates with bupropion and other treatments, 15,20,45–53 and 1 which was a meta-analysis. 54 The remaining 10 articles were then entered into the current meta-analysis (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…10,11 In these studies, bupropion has been reported to be safe and to carry the least risk of phase shifting among other antidepressants based on current evidence. 11,38 However, an increasing number of studies have reported their clinical experience of bupropion usage in clinical practice 4,12,15,20,43,46,55 in recent years, and thus the safety of bupropion with regard to phase shifting needs to be seriously reconsidered. The present study provides up-to-date key information about the safety of bupropion in BD patients.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 However, with increasing clinical experience of the usage of bupropion, an increasing number of clinical studies have reported phase shifting in BD patients related to the use of bupropion. 12–18 The safety of bupropion as monotherapy or combination therapy in the treatment of BD patients has thus attracted the attention of clinicians 19,20 and prompted further research to evaluate the role of bupropion in the treatment of BD. Therefore, the aim of the present study was to summarize the current data about the role of bupropion, including the treatment effect and safety profile, in the treatment of BD via a thorough meta-analysis.…”

Section: Introductionmentioning

confidence: 99%

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Significant Treatment Effect of Bupropion in Patients With Bipolar Disorder but Similar Phase-Shifting Rate as Other Antidepressants

Tseng

Chen

et al. 2016

Medicine

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Bupropion is widely used for treating bipolar disorder (BD), and especially those with depressive mood, based on its good treatment effect, safety profile, and lower risk of phase shifting. However, increasing evidence indicates that the safety of bupropion in BD patients may not be as good as previously thought.The aim of this study was to summarize data on the treatment effect and safety profile of bupropion in the treatment of BD via a meta-analysis.Electronic search through PubMed and ClinicalTrials.gov was performed.The inclusion criteria were: (i) studies comparing changes in disease severity before and after bupropion treatment or articles comparing the treatment effect of bupropion in BD patients with those receiving other standard treatments; (ii) articles on clinical trials in humans. The exclusion criteria were (i) case reports/series, and (ii) nonclinical trials.All effect sizes from 10 clinical trials were pooled using a random effects model. We examined the possible confounding variables using meta-regression and subgroup analysis.Bupropion significantly improved the severity of disease in BD patients (P < 0.001), and the treatment effect was similar to other antidepressants/standard treatments (P = 0.220). There were no significant differences in the dropout rate (P = 0.285) and rate of phase shifting (P = 0.952) between BD patients who received bupropion and those who received other antidepressants.We could not perform a detailed meta-analysis of every category of antidepressant, nor could we rule out the possible confounding effect of concurrent psychotropics or include all drug side effects. Furthermore, the number of studies recruited in the meta-analysis was relatively small.Our findings reconfirm the benefits of bupropion for the treatment of bipolar depression, which are similar to those of other antidepressants. However, the rate of phase shifting with bupropion usage was not as low compared to other antidepressants as previously thought, which should serve to remind clinicians of the risk of phase shifting when prescribing bupropion to BD patients regardless of the suggestions of current clinical practice guidelines.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Significant Treatment Effect of Bupropion in Patients With Bipolar Disorder but Similar Phase-Shifting Rate as Other Antidepressants

Tseng

Chen

et al. 2016

Medicine

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“… 7 , 9 , 10 The overall prescription change, with replacement of risperidone and olanzapine with quetiapine and the doubling in scripts of lamotrigine, is consistent with a South Korean observational study on the transition from acute to maintenance treatment in BD. 19 The increase in quetiapine use is probably related to its efficacy in treating the emergence of depressive symptoms during maintenance care.…”

Section: Discussionmentioning

confidence: 99%

A retrospective record review and assessment of cost of quetiapine use in a community psychiatric setting in the Sedibeng district of Gauteng

2017

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BackgroundWith the revision of the National Essential Medicines List in South Africa, quetiapine is only available at the discretion of individual institutions in the public health sector. However, quetiapine is effective in managing all aspects of bipolar disorder, including preventative treatment of depressive episodes, and may be a cost-effective option in severe illness.AimTo present the first retrospective review of quetiapine use in a peri-urban health district of South Africa, describing the patient profile, clinical response and prescribing patterns.MethodsThe clinical files of all patients in Sedibeng District who received quetiapine over a defined 3-year period (2011–2013) were reviewed. A positive clinical response was defined as both symptomatic and functional improvement. Demographic and clinical characteristics of responders were compared with that of non-responders. Pre- and post-quetiapine scripts of the responders were audited and costed.ResultsPatients who received quetiapine (n = 40) had chronic disabling illness, often with multiple medication trials and hospitalisations prior to quetiapine use. Bipolar II disorder (followed by bipolar I disorder) was the most common primary psychiatric diagnosis documented. Other than improvement in functioning (p < 0.0001), responders differed significantly from non-responders in terms of a higher level of polypharmacy and a significant reduction in median number of medications from pre- to post-quetiapine (p = 0.0057).ConclusionQuetiapine use was associated with a highly significant improvement in functioning; however, it came at a 52% increase in medicine cost. Pre-quetiapine treatments, though, did not achieve an optimal level of functioning, and overall costs may be reduced by more rational prescribing habits.

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“…Regarding dosing, a Korean study estimated an average total daily dose of lithium carbonate of 970 mg and of disodium valproate at 1082 mg among BD patients recovering from acute episodes of illness. 10 Another Asian study reported on the ratio of the prescribed daily dose of MSs to a defined, standard daily dose, 11 finding a mean ± SD ratio of 0.62 ± 0.29, suggesting relatively conservative dosing. 7 To compare doses of specific MSs, it is helpful to have a way to standardize doses.…”

mentioning

confidence: 99%

Dosing of Mood Stabilizers for Bipolar Disorder Patients in the Research on Asian Psychotropic Prescription Patterns Consortium Study

Wang¹,

Chew

Lin

et al. 2022

J Clin Psychopharmacol

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BackgroundBecause use and dosing of mood stabilizers (MSs) to treat bipolar disorder (BD) patients in Asia are not well documented, we examined prevalence and clinical correlates of treatment of Asian BD patients with relatively high doses of MSs.MethodsWe conducted a pharmacoepidemiological survey across 13 Asian countries and territory in the Research on Asian Psychotropic Prescription Patterns Consortium. Mood stabilizer doses were converted to lithium carbonate equivalents (Li-eq milligrams per day). We compared relatively high (>900 Li-eq mg/day) versus lower MS doses by bivariate comparisons, followed by multivariable linear regression to identify factors associated with higher MS doses.ResultsAmong 1647 participants, MS dose averaged 584 (confidence interval, 565–603 Li-eq mg/d). Preliminarily, the 13.1% of the subjects given greater than 900 mg/d versus those given lower doses were younger, male, currently hospitalized, not currently depressed, and reported lifetime suicidal ideation; they also received relatively high doses of antipsychotics, received electroconvulsive treatment within the previous 12 months, and had greater ratings of tremors and sedation. By linear regression modeling, the mean proportion given high doses of MS was associated significantly and independently with higher doses of antipsychotics, younger age, male sex, hospitalized, more years of illness, country, higher body mass index, recent electroconvulsive treatment, and being in illness remission.ConclusionsRelatively high doses of MSs for BD are prevalent, but vary markedly among Asian countries, and are particularly likely among young males, ill for many years, and given high doses of antipsychotics or ECT. These characteristics allow better identification of patient profiles that can guide treatment of BD patients.

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Current prescription pattern of maintenance treatments for bipolar patients in Korea: A focus on the transition from acute treatments

Cited by 10 publications

References 24 publications

Significant Treatment Effect of Bupropion in Patients With Bipolar Disorder but Similar Phase-Shifting Rate as Other Antidepressants

Significant Treatment Effect of Bupropion in Patients With Bipolar Disorder but Similar Phase-Shifting Rate as Other Antidepressants

A retrospective record review and assessment of cost of quetiapine use in a community psychiatric setting in the Sedibeng district of Gauteng

Dosing of Mood Stabilizers for Bipolar Disorder Patients in the Research on Asian Psychotropic Prescription Patterns Consortium Study

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