title: Drug treatment patterns in bipolar disorder: analysis of long-term self-reported data.
abstract: BACKGROUND
  The objective of this study is to investigate drug treatment patterns in bipolar disorder using daily data from patients who received treatment as usual.
  
  
  METHODS
  Patients self-reported the drugs taken daily for about 6 months. Daily drug use and drug combinations were determined for each patient, both by the specific drugs and by medication class. The drug load was calculated for all drugs taken within a medication class.
  
  
  CONCLUSIONS
  Four hundred fifty patients returned a total of 99,895 days of data (mean 222.0 days). The most frequently taken drugs were mood stabilizers. Of the 450 patients, 353 (78.4%) took a stable drug combination for ≥50% of days. The majority of patients were taking polypharmacy, including 75% of those with a stable combination. Only a small number of drugs were commonly taken within each medication class, but there were a large number of unique drug combinations: 52 by medication class and 231 by specific drugs. Eighty percent of patients with a stable combination were taking three or less drugs daily. Patients without a stable combination took drugs but made frequent changes. Taking more than one drug within a medication class greatly increased the drug load. To summarize, (1) patients were more likely to take a mood stabilizer than any other drug; (2) although most patients were taking polypharmacy, there were no predominant drug regimens even among those taking a stable combination; and (3) most patients with a stable combination take a relatively small number of drugs daily. The wide variation in drug regimens and numerous possible drug combinations suggest that more evidence is needed to optimize treatment of bipolar disorder.
authors.affiliation: Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, Dresden, 01307 Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
authors.affiliation: ChronoRecord Association Inc., Fullerton, CA 92834 USA.
authors.forename: Tasha
authors.initials: T
authors.lastname: Glenn
authors.affiliation: Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2 Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Alda
authors.affiliation: Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO 64110 USA.
authors.forename: Kemal
authors.initials: K
authors.lastname: Sagduyu
authors.affiliation: Department of Psychiatry, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655 USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Marsh
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario M5S 1A1 Canada ; Mood Disorders Centre of Ottawa, Ottawa, Ontario K1G 4G3 Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Grof
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, CA 92093 USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Munoz
authors.affiliation: Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, Dresden, 01307 Germany.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Severus
authors.affiliation: Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, Dresden, 01307 Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Ritter
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA), 300 UCLA Medical Plaza, Los Angeles, CA 90095 USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Whybrow
keywords: Bipolar disorder; Drug load; Drug treatment patterns; Polypharmacy