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Adherence to Bipolar Disorder Treatment Guidelines Minimal: Presented at APA

NEW YORK, NY -- May 6, 2004 -- Adherence to American Psychiatric Association guidelines for the initial treatment of patients with bipolar depression is minimal, with only 9% of patients receiving a recommended treatment, a retrospective study of over 1200 patients shows.

Contraindicated therapy -- monotherapy with an antidepressant -- was chosen as the initial therapy in 16% of cases, reported Nancy deLay, PhD, a health outcomes research scientist at Eli Lilly and Company's Lilly Research Laboratories in Indianapolis, Indiana. Dr. DeLay presented the findings here on May 4^th at the American Psychiatric Association Annual Meeting.

"Until very recently, very few drugs had Food and Drug Administration approval for the treatment of bipolar disorder, and none had an indication specifically for the depressive phase," she said. Now there is 1 drug approved for the depressive phase.

Given this environment, the goal of the study was to identify medication treatment patterns for patients presenting in the depressive phase of the illness, Dr. deLay said.

For the study, the researchers analyzed treatment patterns among a cohort of 1203 patients who had been diagnosed with bipolar depression and had received an antidepressant, antipsychotic, benzodiazepine, or mood stabilizer. The average age of the patients was 42 years, and 34% were male.

Initially, according to study results, 39% of the patients were prescribed an antidepressant, 31% were given a mood stabilizer, and 15% were given a benzodiazepine, while the rest were prescribed an antipsychotic.

As for the number of products prescribed as initial treatment, 26% of the patients were on monotherapy, 28% were on 2 drugs, 24% were on 3 drugs, 14% were on 4 drugs, and 8% were on more than 4 drugs, Dr. deLay reported. Family practitioners were twice as likely to prescribe monotherapy as were psychiatrists, she said.

Over the first year, more than 1000 patients had a switch in medication, she said, while over half of the patients had 3 or more treatment switches.

As the number of switches rose, the percentage of patients on monotherapy decreased by 12% and the use combination therapy with 4 or more medications rose by 9%, the study showed.

Also, although depakote and lithium are considered the gold standard for therapy, the drugs were prescribed to only one third and one quarter of patients, respectively, Dr. deLay said.

"The treatment of bipolar depression is characterized by polypharmacy, multiple switches in treatment, and very little adherence to APA guidelines," Dr. deLay said. "Better education and better dissemination of the guidelines are needed."

Eli Lilly and Company supported the research.


[Presentation title: "Medication prescribing patterns for patients with bipolar depression." Abstract # NR352]

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