Psychotropic Medications for Patients With Bipolar Disorder

Article

Psychotropic Medications for Patients With Bipolar Disorder in the United States: Polytherapy and Adherence

Ross Baldessarini, M.D., Henry Henk, Ph.D., Ami Sklar, M.P.H., Jane Chang, M.P.H. and Leslie Leahy, Ph.D.

Dr. Baldessarini is affiliated with the Department of Psychiatry, Harvard Medical School, Boston. Dr. Henk and Ms. Sklar are with the Department of Health Economics and Outcomes Research, i3 Innovus, Eden Prairie, Minnesota. At the time this study was conducted, Ms. Chang and Dr. Leahy were with the Department of Research, Novartis Corporation, East Hanover, New Jersey. Send correspondence to Dr. Baldessarini at the McLean Division of Massachusetts General Hospital, 115 Mill St., Belmont, MA 02478-9106 (e-mail: rjb@mclean.org ). Preliminary findings were presented at the annual meeting of the American Psychiatric Association, May 19–24, 2007, San Diego, California.

OBJECTIVE: Because treatments for bipolar disorder include a growing number of psychotropic agents, the authors evaluated psychotropic polytherapy and adherence to treatment among U.S. patients with bipolar disorder. METHODS: National health plan claims data (2000–2004) were used to identify patients diagnosed as having bipolar disorder who had continuous benefits and had not been prescribed medication for bipolar disorder for six months or more. The study compared drugs dispensed to these patients initially and at one year and characterized patients who were adherent to mood-stabilizers. RESULTS: A total of 7,406 patients had a bipolar disorder: bipolar I (55%), bipolar II (15%), or bipolar disorder not otherwise specified (30%). Women represented 57% of the sample; mean±SD age was 35.4±12.4 years. Initial prescription fills involved one psychotropic agent in 67% of patients, and two or more psychotropics (polytherapy) in 33%. Initial prescription drug selections involved: antidepressants > anticonvulsants > antipsychotics > sedatives > lithium; initial mood stabilizer use ranked: valproate > lithium > carbamazepine or oxcarbazepine > lamotrigine; antipsychotics ranked: olanzapine > quetiapine> risperidone > ziprasidone > aripiprazole > clozapine. Rankings were similar at one year, when only 31% of patients received monotherapy (a 2.2-fold decline), 32% received polytherapy, and 37% received no psychotropics. Initially patients received 1.42 psychotropic drugs per person; at one year, patients received 175, and at both times polytherapy was less likely with lithium than with anticonvulsants. In multivariate modeling, one-year mood stabilizer use was greater with the following: older age, type of mood stabilizer (lamotrigine > valproate > carbamazepine or oxcarbazepine > lithium) and was associated with more psychiatric office and emergency visits, clinician type (more common with psychiatrists than with primary care physicians), and nonuse of off-label anticonvulsants. CONCLUSIONS: Polytherapy was used by one-third of patients initially and at one year, antidepressant use was highly prevalent initially and later, but lack of treatment was prevalent at one year. Plausible clinical and treatment factors were associated with sustained mood stabilizer adherence.


Related Articles:

October 2008: This Month's Highlights
Psychiatr Serv 2008 59: 1089. [Full Text] [PDF]


Meta-analysis of Major Depressive Disorder Relapse and Recurrence With Second-Generation Antidepressants
Richard Hansen, Bradley Gaynes, Patricia Thieda, Gerald Gartlehner, Angela Deveaugh-Geiss, Erin Krebs, and Kathleen Lohr
Psychiatr Serv 2008 59: 1121-1130. [Abstract] [Full Text] [PDF]
Antidepressant Use in Black and White Populations in the United States
Hector M. González, Thomas Croghan, Brady West, David Williams, Randolph Nesse, Wassim Tarraf, Robert Taylor, Ladson Hinton, Harold Neighbors, and James Jackson
Psychiatr Serv 2008 59: 1131-1138. [Abstract] [Full Text] [PDF]
Guideline-Consistent Antidepressant Treatment Patterns Among Veterans With Diabetes and Major Depressive Disorder
Anjali Tiwari, Mangala Rajan, Donald Miller, Leonard Pogach, Mark Olfson, and Usha Sambamoorthi
Psychiatr Serv 2008 59: 1139-1147. [Abstract] [Full Text] [PDF]
Changing Trends in Pediatric Antipsychotic Use in Florida's Medicaid Program
Robert Constantine and Rajiv Tandon
Psychiatr Serv 2008 59: 1162-1168. [Abstract] [Full Text] [PDF]
Trends in Use of Antipsychotics and Mood Stabilizers Among Medicaid Beneficiaries With Bipolar Disorder, 2001–2004
Colin Depp, Victoria D. Ojeda, William Mastin, Jürgen Unützer, and Todd P. Gilmer
Psychiatr Serv 2008 59: 1169-1174. [Abstract] [Full Text] [PDF]
Pharmacologic Treatment of Posttraumatic Stress Disorder Among Privately Insured Americans
Ilan Harpaz-Rotem, Robert A. Rosenheck, Somaia Mohamed, and Rani A. Desai
Psychiatr Serv 2008 59: 1184-1190. [Abstract] [Full Text] [PDF]
Dosing Frequency and Adherence to Antipsychotic Medications
Paul N. Pfeiffer, Dara Ganoczy, and Marcia Valenstein
Psychiatr Serv 2008 59: 1207-1210. [Abstract] [Full Text] [PDF]

No comments:

HOME (*Revenire-Pagina la Zi)

MENU

EDITORIAL