title: Polypharmacy in Maintenance of Bipolar Disorder.
abstract: OBJECTIVE
  To track the outcomes of bipolar patients who had remitted from an acute manic episode on single- and multiple-drug regimens including lithium (LI), valproate (VPA), and carbamazepine (CBZ), in order to compare relapse rates on 1, 2, or 3 medications.
  
  
  METHODS
  Following treatment of an acute manic episode and a 1-month period of no signs of mood episodes, patients were evaluated at 1- to 2-month intervals as to the kind of regimen required to maintain their stability while continuing on this regimen for 2 years. Medication regimens included 1, 2, or 3 of the following drugs: LI, VPA, and/or CBZ. The 3 medication groups were followed from entry into the study through 3 possible end points based on the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition checklist: "NO-Relapse," "Relapse," or "Dropped out."
  
  
  RESULTS
  Of the 1312 patients included in the study and followed up for 2 years, 281 patients (21.4%) were maintained on a single drug (LI, VPA, or CBZ), 852 (65%) on 2 drugs, and 179 (13.6%) on 3 or more drugs. A smaller percentage of patients on 1 medication had NO-Relapse for 2 years (22.8%), compared with patients on 2 medications (43.9%) and patients on 3 or more medications (41.9%): χ2 = 40.3, P < 0.001.
  
  
  CONCLUSIONS
  This study showed that overall, of the bipolar patients who were asymptomatic at 1 month, a smaller percentage of patients on 1 medication continued to be stable for 2 years, compared with patients on 2 medications and patients on 3 or more medications.
authors.affiliation: *Richmond University Medical Center and Freedom From Fear, Staten Island, NY; †Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona; and ‡Cedars-Sinai Medical Center, and §David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peselow
authors.forename: Lancer
authors.initials: L
authors.lastname: Naghdechi
authors.forename: Demetria
authors.initials: D
authors.lastname: Pizano
authors.forename: Waguih William
authors.initials: WW
authors.lastname: IsHak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents