title: Trends in pharmacotherapy in patients referred to a bipolar specialty clinic, 2000-2011.
abstract: OBJECTIVE
  To assess mood stabilizer (MS) and second-generation antipsychotic (SGA) prescribing trends in bipolar disorder (BD) outpatients referred to a bipolar disorder specialty clinic over the past 12 years.
  
  
  METHODS
  BD outpatients referred to the Stanford University Bipolar Disorder Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation. Prescription rates for MSs and SGAs were compared during the first (2000-2005) and second (2006-2011) six years.
  
  
  RESULTS
  Among 597 BD patients (mean±SD age 35.4±8.6 years; 58.1% female; 40.7% Type I, 43.6% Type II, and 15.7% Type Not Otherwise Specified; taking 2.6±1.7 prescription psychotropic medications), lamotrigine, quetiapine, and aripiprazole usage more than doubled, from 14.7% to 37.2% (p<0.0001), 7.2% to 19.7% (p<0.0001), and 3.1% to 10.9% (p=0.0003), respectively, while olanzapine and risperidone use decreased by more than half from 15.0% to 6.6% (p=0.0043), and from 8.7% to 3.8% (p=0.039), respectively. SGA use increased from 34.1% to 44.8% (p=0.013), although MS use continued to be more common (in 65.2% for 2006-2011). Use of other individual MSs and SGAs and MSs as a class did not change significantly.
  
  
  CONCLUSIONS
  Over 12 years, in patients referred to a BD specialty clinic, lamotrigine, quetiapine, and aripiprazole use more than doubled, and olanzapine and risperidone use decreased by more than half. Tolerability (for lamotrigine, aripiprazole, olanzapine, and risperidone) more than efficacy (for quetiapine) differences may have driven these findings. Additional studies are needed to explore the relative influences of enhanced tolerability versus efficacy upon prescribing practices in BD patients.
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723, USA.
authors: Farnaz
authors: F
authors: Hooshmand
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723, USA; Sierra Pacific Mental Illness Research Education and Clinical Centers, Palo Alto VA Health Care System, Palo Alto, CA, USA.
authors: Shefali
authors: S
authors: Miller
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723, USA.
authors: Jennifer
authors: J
authors: Dore
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723, USA.
authors: Po W
authors: PW
authors: Wang
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723, USA.
authors: Shelley J
authors: SJ
authors: Hill
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723, USA.
authors: Natalie
authors: N
authors: Portillo
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723, USA. Electronic address: tketter@stanford.edu.
authors: Terence A
authors: TA
authors: Ketter
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000554:Ambulatory Care Facilities; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D002140:California; D003987:Dibenzothiazepines / Q000627:therapeutic use; D004358:Drug Therapy / Q000639:trends; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D000077152:Olanzapine; D010879:Piperazines / Q000627:therapeutic use; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000627:therapeutic use; D012017:Referral and Consultation; D018967:Risperidone / Q000627:therapeutic use; D014227:Triazines / Q000627:therapeutic use
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D015363:Quinolones; D014227:Triazines; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D000068180:Aripiprazole; D018967:Risperidone; D000077152:Olanzapine; D000077213:Lamotrigine
keywords: Aripiprazole; Lamotrigine; Lithium; Olanzapine; Quetiapine; Valproate