What not to use in bipolar disorders: A systematic review of non-recommended treatments in clinical practice guidelines

Gomes, Fabiano A.; Cerqueira, Raphael O.; Lee, Yena; Mansur, Rodrigo B.; Kapczinski, Flávio; McIntyre, Roger S.; Yatham, Lakshmi N.; Berk, Michael; Milev, Roumen; Brietzke, Elisa

doi:10.1016/j.jad.2021.11.007

Cited by 8 publications

(10 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, an alarming 45.1% prevalence of total antidepressant use at 3 months was seen in patients first diagnosed in 2006–2010 (sub‐cohort 3) and 45.0% in patients diagnosed in 2001–2005 (sub‐cohort 2). These findings are concerning and reflect an inadequate adherence to the evidence‐based treatment recommendations: as concluded earlier, the use of antidepressants alone is discouraged due to increased risk of treatment‐emergent mania, mood destabilization and suicide in patients with BD 4,6,7,10 . In addition, very limited evidence on the efficacy and safety of adjunctive treatment with antidepressants has been presented 4,10 .…”

Section: Discussionmentioning

confidence: 99%

“…These findings are concerning and reflect an inadequate adherence to the evidence‐based treatment recommendations: as concluded earlier, the use of antidepressants alone is discouraged due to increased risk of treatment‐emergent mania, mood destabilization and suicide in patients with BD. 4 , 6 , 7 , 10 In addition, very limited evidence on the efficacy and safety of adjunctive treatment with antidepressants has been presented. 4 , 10 According to our data, the decline in the cumulative first‐year incidence of antidepressant use started in 2008, which coincided with the publication of the first national care guideline for bipolar disorder in Finland, which might have helped to steer medication practices towards more evidence‐based ones.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 6 , 7 , 10 In addition, very limited evidence on the efficacy and safety of adjunctive treatment with antidepressants has been presented. 4 , 10 According to our data, the decline in the cumulative first‐year incidence of antidepressant use started in 2008, which coincided with the publication of the first national care guideline for bipolar disorder in Finland, which might have helped to steer medication practices towards more evidence‐based ones. However, the point‐prevalence of antidepressants was still 29.5% (95% CI 28.8–30.1) after 5 years of diagnosis despite that antidepressants are not recommended in the most recent CPGs or in research to be used for the long‐term treatment of BD.…”

Section: Discussionmentioning

confidence: 99%

“…2,[4][5][6][7] While the treatment recommendations for bipolar depression are more controversial and less studied, 3,8 most CPGs agree on recommending against the use of antidepressants as a monotherapy and some even as an adjunctive. [8][9][10] Importantly, despite this discouragement towards antidepressant use, studies show that antidepressants are prescribed commonly for patients with bipolar depression. [11][12][13] Instead of antidepressants, recent CPGs recommend quetiapine, lurasidone, lithium, and lamotrigine as first-line treatment options for the treatment of bipolar depression.…”

Section: Introductionmentioning

confidence: 99%

“…While the treatment recommendations for bipolar depression are more controversial and less studied, 3,8 most CPGs agree on recommending against the use of antidepressants as a monotherapy and some even as an adjunctive 8–10 . Importantly, despite this discouragement towards antidepressant use, studies show that antidepressants are prescribed commonly for patients with bipolar depression 11–13 .…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Twenty‐year medication use trends in first‐episode bipolar disorder

Poranen

Koistinaho

Tanskanen

et al. 2022

Acta Psychiatr Scand

View full text Add to dashboard Cite

Objectives To study the medication use patterns in patients newly diagnosed with bipolar disorder (BD) in Finland during the past 20 years. Methods All persons diagnosed with BD between 1996 and 2018, aged 16–65 years, with no previous BD diagnosis were identified from nationwide Finnish registers (N = 26,395). The point prevalences of medication use were observed up until 5 years after the first diagnosis. Five sub‐cohorts according to calendar year of first diagnosis were also formed and the prevalence of medication use was compared between sub‐cohorts 3 months after diagnosis. Medication data were modeled with the PRE2DUP‐method using dispensing data. Results The prevalence of overall medication use declined during the 5‐year follow‐up period in the total cohort. The highest prevalence of use was seen 3 months after diagnosis for the three main medication classes–antidepressants (40.8%), antipsychotics (30.8%) and mood stabilizers (29.2%). The prevalence of lithium use varied between 5.9% and 6.5% during the 5 years in the total cohort, and the lowest prevalence of use at 3 months was seen in sub‐cohort diagnosed in 2016–2018 (4.1%) versus 12.1% in 1996–2000 sub‐cohort. The prevalence of benzodiazepine use was between 12.4% and 13.5% and the prevalence of Z‐drugs was between 7.3% and 7.9% during the 5 years. The prevalence of long‐acting injectable antipsychotic (LAI) use was the highest in patients diagnosed in 2016–2018, although still only 0.8%. Conclusions (i) The use of antidepressants is too prevalent, (ii) the use of lithium is declining and needs to be increased, and (iii) LAIs are markedly underutilized as compared to their oral counterparts.

show abstract

Section: Discussionmentioning

confidence: 99%