Prescription Patterns for Bipolar Disorder in Asian Countries: Findings from Research on Asian Prescription Pattern-Bipolar Disorder

Abstract

Objective: Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed. Methods: The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≥ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method. Results: Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries. 62 S.K. Lin, et al.Conclusion: Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≥ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment.

Clozapine Use for Bipolar Disorder

“…We conducted a cross-sectional survey between May and September, 2018, across 13 Asian countries and regions (China, Hong Kong SAR, India, Indonesia, Japan, Korea, Malaysia, Myanmar, Pakistan, Singapore, Sri Lanka, Taiwan, Thailand) affiliated with the REAP Prescription Patterns Consortium 23,24 . All participating centers obtained ethical approval from their local institutional review boards as well as the informed consent of all participants at the time of recruitment.…”

“…We conducted a cross-sectional survey between May and September, 2018, across 13 Asian countries and regions (China, Hong Kong SAR, India, Indonesia, Japan, Korea, Malaysia, Myanmar, Pakistan, Singapore, Sri Lanka, Taiwan, Thailand) affiliated with the REAP Prescription Patterns Consortium. 23,24 All participating centers obtained ethical approval from their local institutional review boards as well as the informed consent of all participants at the time of recruitment. Two major inclusion criteria were (a) participants had to fulfill diagnostic criteria for BD based on the International Classification of Diseases, 10th Revision (WHO, 1992) or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (APA, 2013) and (b) participants were deemed sufficiently clinically stable by their psychiatrists to participate.…”

Patterns of pharmacotherapy for bipolar disorder: A GBC survey

“…3,4 The bipolar pharmacopoeia has evolved gradually over the last 25 years. Several studies have explored the pharmacotherapeutic prescription practices in BD and reported variable patterns of pharmacologic treatment, [5][6][7][8] most notably the underutilization of lithium (Li) in the United States. 9 Based on regulatory drug development, the use of secondgeneration antipsychotics (SGAs) has steadily increased.…”

“…[12][13][14] A recent study investigating the prescription patterns for BD in Asian countries reported that >80% of patients received mood stabilizers (MSs) and/or antipsychotics, with 20% of patients receiving complex polypharmacy. 7 An international survey investigating pharmacotherapeutic practices across different geographic regions would help to understand the global variabilities in BD treatment and potential outcomes.…”

Korean Medication Algorithm Project for Bipolar Disorder 2022, Fifth Revision: An Executive Summary

“…Bipolar disorder is a chronic and debilitating psychiatric disorder characterized by recurring manic or hypomanic episodes that may alternate with depressive episodes [ 1 ]. Pharmacotherapy has been the cornerstone treatment for bipolar disorder since the introduction of lithium (LIT) in the late 1960s and early 1970s [ 2 , 3 ]. Despite substantial progress in psychopharmacology during the past several decades, a significant proportion of patients with bipolar disorder suffer from treatment failure [ 4 ].…”