Prescribing trends of antidepressants in bipolar depression.
BACKGROUND
This study utilizing pharmacoepidemiologic methods was undertaken to determine the prescribing patterns of antidepressants particularly in bipolar depression.


METHODS
From pharmacy records of the McLean Hospital, the number of patients receiving antidepressants and given electroconvulsive therapy (ECT) from June 1, 1987, to May 8, 1993, was determined. We later linked these data bases with patients who were diagnosed with DSM-III-R bipolar depression (296.5) during the same period of time.


RESULTS
During the 6-year period, it was determined that 3829 inpatients had received tricyclic antidepressants (TCAs), 2981 fluoxetine, 2603 trazodone, 809 bupropion, 743 monoamine oxidase inhibitors (MAOIs), 592 stimulants, 588 sertraline, 48 paroxetine, and 894 ECT. There were significant increases over time in prescriptions of MAOIs compared with fluoxetine (chi 2 = 14.36, p = .006), and bupropion compared with TCAs (chi 2 = 6.45, p = .04). There was a trend for bupropion to be prescribed more over time compared with fluoxetine (chi 2 = 5.09, p = .08). There were no significant changes in the prescribing of other antidepressants or in the use of ECT.


CONCLUSIONS
At our center, prescribing of bupropion and MAOIs in bipolar depression has increased significantly. This may be related to the reports in the literature of the low switch rates to mania with the use of these drugs.
Zarate
C A
CA
Pharmacoepidemiology Center, McLean Hospital, Belmont, Mass. 02178, USA.
Tohen
M
M
Baraibar
G
G
Kando
J C
JC
Mirin
J
J
D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy; D016642:Bupropion / Q000008:administration & dosage; D003131:Combined Modality Therapy; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000639:trends; D004565:Electroconvulsive Therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D016239:MEDLINE; D008297:Male; D008996:Monoamine Oxidase Inhibitors / Q000008:administration & dosage; D017891:Pharmacoepidemiology; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data / Q000639:trends
D000928:Antidepressive Agents; D008996:Monoamine Oxidase Inhibitors; D016642:Bupropion