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

Adult Age Factors Ambulatory Care / statistics & numerical data Bipolar Disorder / drug therapy Drug Utilization / trends Ethnicity Female Health Care Surveys / methods Humans Male Mental Health Services / statistics & numerical data Practice Patterns, Physicians' / trends Psychiatry Psychotropic Drugs / classification Sex Factors United States / epidemiology
Antipsychotics Bipolar Disorder Lithium Outpatient

Journal

The American journal of psychiatry
ISSN: 1535-7228
Titre abrégé: Am J Psychiatry
Pays: United States
ID NLM: 0370512

Informations de publication

Date de publication:
01 08 2020
Historique:
pubmed: 22 4 2020
medline: 8 10 2020
entrez: 22 4 2020
Statut: ppublish

Résumé

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. 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. 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). 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.

Identifiants

DOI: 10.1176/appi.ajp.2020.19091000 PMID: 32312111 PMC: PMC7577523
pubmed: 32312111
doi: 10.1176/appi.ajp.2020.19091000
pmc: PMC7577523
mid: NIHMS1624695
doi:

Substances chimiques

Psychotropic Drugs 0

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

706-715

Subventions

Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH107452
Pays : United States
Organisme : NIA NIH HHS
ID : T32 AG019134
Pays : United States
Organisme : AHRQ HHS
ID : K12 HS023000
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA019606
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA039137
Pays : United States

Commentaires et corrections

Type : CommentIn
Type : CommentIn
Type : CommentIn

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Auteurs

Taeho Greg 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).

Mark 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).

Andrew A 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).

Samuel T 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).

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