Clinical Use of Mood Stabilizers With Antidepressants in Asia: Report From the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) Projects in 2004 and 2013.
OBJECTIVE
As most reports concerning treatment with combinations of mood stabilizer (MS) with antidepressant (AD) drugs are based in the West, we surveyed characteristics of such cotreatment in 42 sites caring for the mentally ill in 10 Asian countries.


METHODS
This cross-sectional, pharmacoepidemiologic study used 2004 and 2013 data from the REAP-AD (Research Study on Asian Psychotropic Prescription Patterns for Antidepressants) to evaluate the rates and doses of MSs given with ADs and associated factors in 4164 psychiatric patients, using standard bivariate methods followed by multivariable logistic regression modeling.


RESULTS
Use of MS + AD increased by 104% (5.5% to 11.2%) between 2004 and 2013 and was much more associated with diagnosis of bipolar disorder than major depression or anxiety disorder, as well as with hospitalization > outpatient care, psychiatric > general-medical programs, and young age (all P < 0.001), but not with country, sex, or AD dose.


CONCLUSIONS
The findings provide a broad picture of contemporary use of MSs with ADs in Asia, support predictions that such treatment increased in recent years, and was associated with diagnosis of bipolar disorder, treatment in inpatient and psychiatric settings, and younger age.
From the *Department of General Psychiatry, Institute of Mental Health, Singapore; †Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China; ‡Department of Psychiatry, King George's Medical University, Chowk, Lucknow, India; §Department of Psychiatry, Chinese University of Hong Kong, Hong Kong; and ∥National Clinical Research Center for Mental Disorders & the Key Laboratory of Mental Health, Ministry of Health (Peking University), Peking University Institute of Mental Health (the Sixth Hospital), Beijing, China; ¶Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia; #Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India; **Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center and School of Medicine, Chang Gung University, Taiwan; ††Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ‡‡Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China; §§Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea; ∥∥Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan; ¶¶Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; ##Department of Psychiatry, Pushpagiri Medical College, Thiruvalla, India; ***Department of Psychiatry, Hasanuddin University Faculty of Medicine, Makassar, Sulawesi Selatan; and †††Dr Soetomo Hospital - Faculty of Medicine, Airlangga University, Jawa Timur, Indonesia; ‡‡‡Departments of Psychiatry, TMU-Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taiwan; §§§Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Departments of ∥∥∥Psychological Medicine and ¶¶¶Pharmacology, National University of Singapore, Singapore; ###International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan; ****Research Division, Institute of Mental Health, Singapore; ††††International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont; and ‡‡‡‡Department of Psychiatry, Harvard Medical School, Boston, MA.
Kamini
K
Rajaratnam
Yu-Tao
YT
Xiang
Adarsh
A
Tripathi
Helen F K
HF
Chiu
Tian-Mei
TM
Si
Kok-Yoon
KY
Chee
Ajit
A
Avasthi
Sandeep
S
Grover
Mian-Yoon
MY
Chong
Hironori
H
Kuga
Shigenobu
S
Kanba
Yan-Ling
YL
He
Min-Soo
MS
Lee
Shu-Yu
SY
Yang
Pichet
P
Udomratn
Roy A
RA
Kallivayalil
Andi J
AJ
Tanra
Margarita M
MM
Maramis
Winston W
WW
Shen
Norman
N
Sartorius
Ee-Heok
EH
Kua
Chay-Hoon
CH
Tan
Rathi
R
Mahendran
Naotaka
N
Shinfuku
Min Yi
MY
Sum
Ross J
RJ
Baldessarini
Kang
K
Sim
D000328:Adult; D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy; D001208:Asia; D001714:Bipolar Disorder / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000188:drug therapy; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends
D000928:Antidepressive Agents; D018692:Antimanic Agents