Patterns of pharmacotherapy for bipolar disorder: A GBC survey

Abstract

ObjectivesTo understand treatment practices for bipolar disorders (BD), this study leveraged the Global Bipolar Cohort collaborative network to investigate pharmacotherapeutic treatment patterns in multiple cohorts of well‐characterized individuals with BD in North America, Europe, and Australia.MethodsData on pharmacotherapy, demographics, diagnostic subtypes, and comorbidities were provided from each participating cohort. Individual site and regional pooled proportional meta‐analyses with generalized linear mixed methods were conducted to identify prescription patterns.ResultsThis study included 10,351 individuals from North America (n = 3985), Europe (n = 3822), and Australia (n = 2544). Overall, participants were predominantly female (60%) with BD‐I (60%; vs. BD‐II = 33%). Cross‐sectionally, mood‐stabilizing anticonvulsants (44%), second‐generation antipsychotics (42%), and antidepressants (38%) were the most prescribed medications. Lithium was prescribed in 29% of patients, primarily in the Australian (31%) and European (36%) cohorts. First‐generation antipsychotics were prescribed in 24% of the European versus 1% in the North American cohort. Antidepressant prescription rates were higher in BD‐II (47%) compared to BD‐I (35%). Major limitations were significant differences among cohorts based on inclusion/exclusion criteria, data source, and time/year of enrollment into cohort.ConclusionsMood‐stabilizing anticonvulsants, second‐generation antipsychotics, and antidepressants were the most prescribed medications suggesting prescription patterns that are not necessarily guideline concordant. Significant differences exist in the prescription practices across different geographic regions, especially the underutilization of lithium in the North American cohorts and the higher utilization of first‐generation antipsychotics in the European cohorts. There is a need to conduct future longitudinal studies to further explore these differences and their impact on outcomes, and to inform and implement evidence‐based guidelines to help improve treatment practices in BD.

Aripiprazole and Other Third-Generation Antipsychotics as a Risk Factor for Impulse Control Disorders

“…It is possible that, in the populations from which the data are drawn, individuals with bipolar affective disorder may be more likely to receive a TGA than those with schizophrenia spectrum disorders. However, clinical guidelines and treatment practices vary markedly across time and place meaning that the potential influence of confounding by indication is not possible to assess clearly 55,56 . Of the identified articles only Etminan et al 37 examined this directly, and the magnitude of association between aripiprazole and pathological gambling was similar in bipolar disorder compared with other indications.…”

Cognitive rehabilitation in bipolar spectrum disorder: A systematic review

“…For instance, sodium valproate has been reported to worsen cognitive conditions in some cases ( Ebrahimi et al, 2014 ). Moreover, the use of multiple types of medication and the prescription of multiple antipsychotics are on the rise, resulting in notable drug interactions and increased occurrence of side effects ( Singh et al, 2023 ) Given the impact of neurocognitive deficits on BD outcomes, cognitive rehabilitation (CR) strategies ( MacPherson et al, 2021 ) have emerged as potential adjunctive treatments. In recent years, numerous studies have concentrated on adjunctive treatment in bipolar disorder (BD).…”

A naturalistic effectiveness study of maintenance therapies for the bipolar disorders

“…11 Another large international study identified further geographic idiosyncrasies, including lower rates of lithium usage in North America and higher rates of typical antipsychotics in Europe. 12 In short, CPGs can be inconsistent with each other, estimates of prescription rates can be too, and CPG recommendations are often not reflected in prescription patterns. 12 Such factors hinder our ability to draw firm conclusions on first-choice maintenance medications for managing the bipolar disorders.…”

“…12 In short, CPGs can be inconsistent with each other, estimates of prescription rates can be too, and CPG recommendations are often not reflected in prescription patterns. 12 Such factors hinder our ability to draw firm conclusions on first-choice maintenance medications for managing the bipolar disorders. Naturalistic effectiveness data, provided either by clinicians or patients themselves, can potentially be highly informative.…”

“… 11 Another large international study identified further geographic idiosyncrasies, including lower rates of lithium usage in North America and higher rates of typical antipsychotics in Europe. 12 …”