20-Year Trends in the Pharmacologic Treatment of Bipolar Disorder by Psychiatrists in Outpatient Care Settings.

Tytuł:: 20-Year Trends in the Pharmacologic Treatment of Bipolar Disorder by Psychiatrists in Outpatient Care Settings.
Autorzy:: Rhee TG; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington (Rhee); Department of Psychiatry, School of Medicine, Yale University, New Haven, Conn. (Rhee, Wilkinson); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); and Center for Bipolar Treatment Innovation, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Harvard University, Boston (Nierenberg).
Olfson M; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington (Rhee); Department of Psychiatry, School of Medicine, Yale University, New Haven, Conn. (Rhee, Wilkinson); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); and Center for Bipolar Treatment Innovation, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Harvard University, Boston (Nierenberg).
Nierenberg AA; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington (Rhee); Department of Psychiatry, School of Medicine, Yale University, New Haven, Conn. (Rhee, Wilkinson); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); and Center for Bipolar Treatment Innovation, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Harvard University, Boston (Nierenberg).
Wilkinson ST; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington (Rhee); Department of Psychiatry, School of Medicine, Yale University, New Haven, Conn. (Rhee, Wilkinson); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); and Center for Bipolar Treatment Innovation, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Harvard University, Boston (Nierenberg).
Źródło:: The American journal of psychiatry [Am J Psychiatry] 2020 Aug 01; Vol. 177 (8), pp. 706-715. Date of Electronic Publication: 2020 Apr 21.
Typ publikacji:: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
Język:: English
Imprint Name(s):: Original Publication: Arlington, VA : American Psychiatric Association
MeSH Terms:: Bipolar Disorder*/drug therapy
Bipolar Disorder*/epidemiology
Psychotropic Drugs*/classification
Psychotropic Drugs*/therapeutic use
Ambulatory Care/*statistics & numerical data
Mental Health Services/*statistics & numerical data
Practice Patterns, Physicians'/*trends
Adult ; Age Factors ; Drug Utilization/trends ; Ethnicity ; Female ; Health Care Surveys/methods ; Health Care Surveys/statistics & numerical data ; Humans ; Male ; Psychiatry ; Sex Factors ; United States/epidemiology
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Grant Information:: UL1 TR001863 United States TR NCATS NIH HHS; R01 MH107452 United States MH NIMH NIH HHS; T32 AG019134 United States AG NIA NIH HHS; K12 HS023000 United States HS AHRQ HHS; R01 DA019606 United States DA NIDA NIH HHS; R01 DA039137 United States DA NIDA NIH HHS
Contributed Indexing:: Keywords: Antipsychotics; Bipolar Disorder; Lithium; Outpatient
Substance Nomenclature:: 0 (Psychotropic Drugs)
Entry Date(s):: Date Created: 20200422 Date Completed: 20201007 Latest Revision: 20211204
Update Code:: 20240105
PubMed Central ID:: PMC7577523
DOI:: 10.1176/appi.ajp.2020.19091000
PMID:: 32312111
: Czasopismo naukowe

Objective: Pharmacological options for treating bipolar disorder have increased over the past 20 years, with several second-generation antipsychotics receiving regulatory approval in the 1990s. The authors describe trends in use of pharmacological agents in the outpatient management of bipolar disorder.
Methods: Using nationally representative data from the 1997-2016 National Ambulatory Medical Care Surveys, the authors examined trends in the use of mood stabilizers, first- and second-generation antipsychotics, and antidepressants among psychiatrist visits for which bipolar disorder was listed among the primary diagnoses. A logistic regression model was used to identify statistically significant trends, with covariates including age, gender, race/ethnicity, and primary insurance.
Results: Antipsychotics were increasingly more commonly prescribed, increasing from 12.4% of outpatient visits for bipolar disorder in the 1997-2000 period to 51.4% in the 2013-2016 period (adjusted odds ratio=5.05, 95% CI=3.65-7.01). Use of mood stabilizers decreased from 62.3% of visits for bipolar disorder in the 1997-2000 period to 26.4% in the 2013-2016 period (adjusted odds ratio=0.18, 95% CI=0.13-0.27). Prescription of antidepressants occurred in 47.0% of visits for bipolar disorder in the 1997-2000 period and 57.5% in the 2013-2016 period. Prescription of an antidepressant without a mood stabilizer increased substantially, from 17.9% in the 1997-2000 period to 40.9% in the 2013-2016 period (adjusted odds ratio=2.88, 95% CI=2.06-4.03).
Conclusions: Substantial changes have occurred in the treatment of bipolar disorder over the past 20 years, with second-generation antipsychotics in large measure supplanting traditional mood stabilizers. Antidepressant prescriptions persisted despite a lack of evidence for their efficacy in bipolar disorder and concerns about increasing the risk of mania. Research is needed to compare the real-world effectiveness and tolerability of newer antipsychotics with those of traditional mood stabilizers.

Comment in: Aust N Z J Psychiatry. 2020 Jun;54(6):559-560. (PMID: 32513079)
Comment in: Am J Psychiatry. 2020 Aug 1;177(8):647-650. (PMID: 32741277)
Comment in: Front Psychiatry. 2021 Jan 15;11:592593. (PMID: 33519548)

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