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Study Finds Bipolar Prescribing Practices in US Often Not Evidence-Based

September 21, 2020

Despite guidelines against their use as first-line therapy for bipolar disorder, antidepressants were frequently prescribed to patients for initial treatment, according to results from a US claims database analysis presented in a poster at Psych Congress 2020.

“These results suggest many clinicians treating bipolar disorder are not using evidence-based prescribing practices, which can adversely affect health outcomes,” researchers advised.

The study identified adults with newly diagnosed bipolar disorder in commercial, Medicare, and Medicaid health care claims databases for the years 2016 through 2018.

Among 40,345 patients in the commercial claims database, the most common initial episode types were bipolar II disorder and bipolar I depression, according to the poster. Researchers identified 2067 different regimens for initial treatment over 36,587 patients. The most common across all episode types were mood stabilizers (43.8%), antidepressants (42.3%), atypical antipsychotics (31.7%), and benzodiazepines (20.7%). With subsequent lines of therapy, antidepressant (51.4%-53.8%) and benzodiazepine (26.9%-27.4%) use increased.

Among patients with bipolar I depression as their first episode, 14.5% used monotherapy antidepressants as initial treatment. With subsequent lines of therapy, use of antidepressant monotherapy decreased slightly, according to the poster. Among patients with bipolar depression, only 11.8% received guideline-recommended therapy as their initial line of therapy for their first episode, and 9.3% did in the second line of therapy.

The analysis found similar results for patients insured by Medicare and Medicaid, according to the poster.

The findings point to “a substantial opportunity to improve patients’ treatment regimens,” researchers concluded.

AbbVie sponsored the study. 

—Jolynn Tumolo


Jain R, Harrington A, Kong A, Gillard P, Patel M. Bipolar disorder treatment patterns in the United States: a retrospective claims database study. Poster presented at Psych Congress 2020; September 10-13, 2020; Virtual.

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