Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders.
OBJECTIVE
Bipolar disorders are prevalent major illnesses with high rates of morbidity, comorbidity, disability, and mortality. A growing number of psychotropic drugs are used to treat bipolar disorder, often off-label and in untested, complex combinations.


METHODS
To quantify utilization rates for psychotropic drug classes, this study used the 2002-2003 U.S. national MarketScan research databases to identify 7,760 persons with ICD-9 bipolar disorder subtypes. Survival analysis was used to estimate times until initial monotherapies were augmented, changed, or discontinued.


RESULTS
The most commonly prescribed first drug class was antidepressants (50% of patients), followed by mood stabilizers (25%: anticonvulsants, 17%, and lithium, 8%), sedatives (15%), and antipsychotics (11%). At study midpoint only 44% of patients were receiving monotherapy. Those receiving monotherapy were ranked by initial drug prescribed and percentage of patients (bipolar I and bipolar II): antidepressants (55% and 65%), lithium (51% and 41%), antipsychotics (32% and 31%), anticonvulsants (28% and 29%), and sedatives (28%, 25%). Median time to adding another psychotropic was 2.5-times less than median time to changing the initial treatment (16.4 compared with 40.9 weeks), and stopping was rare. Median weeks until therapy was changed in any way for 25% of patients was as follows: lithium, 29 weeks; antidepressants, 13; anticonvulsants, 13; antipsychotics, 13; and sedatives, 9.


CONCLUSIONS
Antidepressants were the first-choice agent twice as often as mood stabilizers. Lithium was sustained longer than monotherapy with other mood stabilizers. Time to augmentation was much shorter than time to change or discontinuation.
Baldessarini
Ross J
RJ
Department of Psychiatry, Harvard Medical School, Boston, MA, USA. rjb@mclean.org
Leahy
Leslie
L
Arcona
Stephen
S
Gause
Douglas
D
Zhang
Winnie
W
Hennen
John
J
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004358:Drug Therapy / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D016651:Lithium Carbonate / Q000627:therapeutic use; D008297:Male; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D000927:Anticonvulsants; D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs; D016651:Lithium Carbonate