title: The utilization of psychopharmacological treatment and medication adherence among Medicaid enrolled children and adolescents with bipolar depression.
abstract: BACKGROUND
  To examine the psychotropic medication utilization and compare adherence to treatment regimens in pediatric bipolar depression patients.
  
  
  METHODS
  2003-2007 MAX data from four geographically diverse states were used. According to the regimen received by the patients (6-18 years) in the first month after the index bipolar depression diagnosis, patients were categorized into six mutually exclusive groups. The month to month change of treatment regimen in each group was then assessed during the 6 month post-index bipolar depression diagnosis. Adherence to each regimen was measured as continuation of the initial regimen, switch to a new regimen, augmentation with medication from a different therapeutic category, and discontinuation of all pharmacotherapies. Repeated measure analysis was conducted to compare the trend of each adherence measure across the study groups.
  
  
  RESULTS
  Of the 5,460 subjects identified, 15.39% received antipsychotic monotherapy, 9.43% received mood stabilizer monotherapy, 5.77% received antidepressant monotherapy, 26.48% received mood stabilizer-antipsychotic polytherapy, 22.51% received antidepressant polytherapy, and 19.89% received antipsychotic-mood stabilizer-antidepressant polytherapy. At the end of the follow-up period, over 50% of the 1st month polytherapy users and less than 50% of the monotherapy users were continuing their initial regimen. Repeated measure analysis using antipsychotic monotherapy as the reference group suggested differences in trend slopes (p<0.05).
  
  
  CONCLUSIONS
  In absence of structured clinical evaluation, bipolar disorder diagnoses cannot be ascertained in this study.
  
  
  CONCLUSIONS
  Bipolar depression patients were predominantly treated with combinations of psychotropic drugs. Potentially questionable practice, such as antidepressant monotherapy was used only in a small fraction of patients. Combination regimens had better adherence as compared to monotherapies.
authors.affiliation: Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, TX, USA.
authors.forename: Debajyoti
authors.initials: D
authors.lastname: Bhowmik
authors.forename: Rajender R
authors.initials: RR
authors.lastname: Aparasu
authors.forename: Suja S
authors.initials: SS
authors.lastname: Rajan
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Sherer
authors.forename: Melissa
authors.initials: M
authors.lastname: Ochoa-Perez
authors.forename: Hua
authors.initials: H
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D014481:United States; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: Antidepressant; Antipsychotic; Bipolar depression; Monotherapy; Mood stabilizer; Polytherapy