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

• Published in: The American journal of psychiatry Vol. 177; no. 8; pp. 706 - 715
• Main Authors: Rhee, Taeho Greg, Olfson, Mark, Nierenberg, Andrew A, Wilkinson, Samuel T
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Association 01.08.2020
• Subjects: Adult; Age Factors; Ambulatory Care - statistics & numerical data; Antidepressants; Bipolar disorder; Bipolar Disorder - drug therapy; Bipolar Disorder - epidemiology; Drug Utilization - trends; Ethnic Groups; Female; Health Care Surveys - methods; Health Care Surveys - statistics & numerical data; Humans; Male; Mental depression; Mental Health Services - statistics & numerical data; Practice Patterns, Physicians' - trends; Psychiatrists; Psychiatry; Psychosis; Psychotropic Drugs - classification; Psychotropic Drugs - therapeutic use; Regulatory approval; Sex Factors; United States - epidemiology; United States; Antipsychotics; Lithium; Bipolar Disorder; Outpatient
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.2020.19091000

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.