Review 40-E-bPC Pharmacoepidemiology of Bipolar Disorder: A Review

Dimos Dimellis, Konstantinos Fountoulakis
Pharmaco-epidemiological research by reflecting the use of drugs in real life situations, is crucial in exploring important public health issues related to psychotropic drug use, such as the medical and economic impact of unjustified extension of use, the identification of infrequent or delayed adverse effects, and the efficiency of new marketed products in naturalistic conditions. The scope of the current presentation is to review systematically the available data on the treatment of bipolar
more » ... atment of bipolar disorder. Material and methods: A systematic MEDLINE search, concerning the treatment of bipolar disorder with 'mania', 'manic', 'bipolar', 'manic-depression', 'manic-depressive' with 'pharmacoepidemiology' or 'prescription' or 'prescrip-tion patterns' or 'therapeutic practice'as keywords, was performed. Results: The literature suggests that the treatment of bipolar disorder is driven by symptomatology and falls short of the existing guidelines. Regarding acute mania, the use of antipsychotics is preferred over lithium or anticonvulsants either as monotherapy or as combination treatment. The data about bipolar depression are scarce and limited although the use of antidepressants is more common in everyday practice than the guidelines advice. Finally, as for the maintenance phase, the use of lithium seems to vary worldwide, whereas the use of antipsychotics is common, especially for those patients with psychotic features or with more complicated course. Astonishingly, 25-50% of bipolar patients are, cross-sectionally, under antidepressants. Overall, less than 40% of patients are on monotherapy and the percentage is falling, while polypharmacy seems to dominate the pharmacotherapy of bipolar disorder, with up to 50% of patients receiving 3 or more psychoactive drugs at the same time. Conclusions: Available data confirm that clinicians do not follow, at least strictly, the proposed guidelines. On the other hand, the effectiveness of the available treatments lies far from ideal, a fact that offers a ground for combinations, despite their increased burden of side effects. There is abundant room for further progress in determining more "clinician friendly" guidelines and treatment choices.