title: Mono- and combination drug therapies in hospitalized patients with bipolar depression. Data from the European drug surveillance program AMSP.
abstract: BACKGROUND
  For the pharmacological treatment of bipolar depression several guidelines exist. It is largely unknown, to what extent the prescriptions in daily clinical routine correspond to these evidence based recommendations and which combinations of psychotropic drugs are frequently used.
  
  
  METHODS
  The prescriptions of psychotropic drugs were investigated of all in-patients with bipolar depression (n = 2246; time period 1994-2009) from hospitals participating in the drug surveillance program AMSP. For the drug use in 2010, 221 cases were analysed additionally.
  
  
  RESULTS
  From 1994 to 2009, 85% of all patients received more than one class of psychotropic substances: 74% received antidepressants in combination therapy, 55% antipsychotics, 48% anticonvulsants and 33% lithium. When given in combination, lithium is the most often prescribed substance for bipolar depression (33%), followed by valproic acid (23%), mirtazapine and venlafaxine (16% each), quetiapine (15%), lamotrigine (14%) and olanzapine (13%). Both, lithium and valproic acid are often combined with selective serotonin reuptake inhibitors (SSRI), but also with mirtazapine und venlafaxine. Combinations of more than one antidepressant occur quite often, whereby combinations with bupropion, paroxetine, fluoxetine or fluvoxamine are very rare. In 2010, quetiapine (alone and combined) was the most frequently prescribed drug (39%); aripiprazole was administered in 10%.
  
  
  CONCLUSIONS
  Combinations of antidepressants (SSRI, mirtazapine, venlafaxine) with mood stabilizers (lithium, valproic acid, lamotrigine) and / or atypical antipsychotics (quetiapine, olanzapine) are common. Of most of those combinations the efficacy has not been studied. The use of aripiprazole and the concomitant use of two or three antidepressants contrast the guidelines.
authors.affiliation: Department of Psychiatry, Ludwig Maximilian University, Munich, Germany, Nussbaumstr, 7, Munich, 80336, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Haeberle
authors.forename: Waldemar
authors.initials: W
authors.lastname: Greil
authors.forename: Stefan
authors.initials: S
authors.lastname: Russmann
authors.forename: Renate
authors.initials: R
authors.lastname: Grohmann
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions / Q000592:standards; D004359:Drug Therapy, Combination / Q000379:methods / Q000592:standards; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007297:Inpatients; D008094:Lithium / Q000627:therapeutic use; D060735:Pharmacovigilance; D011358:Product Surveillance, Postmarketing / Q000379:methods / Q000592:standards
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D008094:Lithium