Patterns of psychotropic drug prescription for US patients with diagnoses of bipolar disorders

被引:50
作者
Baldessarini, Ross J.
Leahy, Leslie
Arcona, Stephen
Gause, Douglas
Zhang, Winnie
Hennen, John
机构
[1] Harvard Univ, Sch Med, Dept Psychiat, Boston, MA 02115 USA
[2] Novartis Pharmaceut, E Hanover, NJ USA
[3] PE Consulting Inc, Media, PA USA
关键词
D O I
10.1176/appi.ps.58.1.85
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Bipolar disorders are prevalent major illnesses with high rates of morbidity, comorbidity, disability, and mortality. A growing number of psychotropic drugs are used to treat bipolar disorder, often off-label and in untested, complex combinations. Methods: To quantify utilization rates for psychotropic drug classes, this study used the 2002-2003 U.S. national MarketScan research databases to identify 7,760 persons with ICD-9 bipolar disorder subtypes. Survival analysis was used to estimate times until initial monotherapies were augmented, changed, or discontinued. Results: The most commonly prescribed first drug class was antidepressants (50% of patients), followed by mood stabilizers (25%: anticonvulsants, 17%, and lithium, 8%), sedatives (15%), and antipsychotics (11%). At study midpoint only 44% of patients were receiving monotherapy. Those receiving monotherapy were ranked by initial drug prescribed and percentage of patients (bipolar I and bipolar 11): antidepressants (55% and 65%), lithium (51% and 41%), antipsychotics (32% and 31%), anticonvulsants (28% and 29%), and sedatives (28%, 25%). Median time to adding another psychotropic was 2.5-times less than median time to changing the initial treatment (16.4 compared with 40.9 weeks), and stopping was rare. Median weeks until therapy was changed in any way for 25% of patients was as follows: lithium, 29 weeks; antidepressants, 13; anticonvulsants, 13; antipsychotics, 13; and sedatives, 9. Conclusions: Antidepressants were the first-choice agent twice as often as mood stabilizers. Lithium was sustained longer than monotherapy with other mood stabilizers. Time to augmentation was much shorter than time to change or discontinuation.
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页码:85 / 91
页数:7
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