Patterns of Psychotropic Drug Prescription for U.S. Patients With Diagnoses of Bipolar Disorders
Psychiatric ServicesPublished 1 January 2007Open access
Ross J. Baldessarini, Leslie Leahy, Stephen Arcona, Douglas Gause, Winnie Zhang, John Hennen
Citations277
SJR quartileQ1
SJR score1.62
SNIP1.35
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Antidepressants were the first-choice agent twice as often as mood stabilizers to treat bipolar disorder, and Lithium was sustained longer than monotherapy with other Mood stabilizers.
Abstract
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.
Keywords
Medicine
Archives of General PsychiatryPrevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication
12,137 Citations2005Ronald C. Kessler, Wai Tat Chiu +2 more
Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity, as shown in the recently completed US National Comorbidities Survey Replication.
Archives of General PsychiatryThe Long-term Natural History of the Weekly Symptomatic Status of Bipolar I Disorder
2,059 Citations2002Lewis L. Judd, Hagop S. Akiskal +7 more
Overall, the symptomatic structure is primarily depressive rather than manic, and subsyndromal and minor affective symptoms predominate, and the longitudinal weekly symptomatic course of BP-I is chronic.
Archives of General PsychiatryA Prospective Investigation of the Natural History of the Long-term Weekly Symptomatic Status of Bipolar II Disorder
1,212 Citations2003Lewis L. Judd, Hagop S. Akiskal +7 more
The longitudinal symptomatic course of BP-II is chronic and is dominated by depressive rather than hypomanic or cycling/mixed symptoms, involving primarily symptoms of minor and subsyndromal severity.
Bipolar DisordersDecreased risk of suicides and attempts during long‐term lithium treatment: a meta‐analytic review
750 Citations2006Ross J. Baldessarini, Leonardo Tondo +4 more
Risks of completed and attempted suicide were consistently lower, by approximately 80%, during treatment of bipolar and other major affective disorder patients with lithium for an average of 18 months, and these benefits were sustained in randomized as well as open clinical trials.
American Journal of PsychiatryPredictors of Recurrence in Bipolar Disorder: Primary Outcomes From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
690 Citations2006Roy H. Perlis, Michael J. Ostacher +12 more
American Journal of PsychiatryLithium in the Prevention of Suicidal Behavior and All-Cause Mortality in Patients With Mood Disorders: A Systematic Review of Randomized Trials
617 Citations2005Andrea Cipriani, H M Pretty +2 more
Lithium is effective in the prevention of suicide, deliberate self-harm, and death from all causes in patients with mood disorders, according to the Cochrane Collaboration.
Archives of General PsychiatryPsychosocial Disability in the Course of Bipolar I and II Disorders
568 Citations2005Lewis L. Judd, Hagop S. Akiskal +7 more
Important findings for clinical management are the following: depressive episodes and symptoms, which dominate the course of BP-I and BP-II, are equal to or more disabling than corresponding levels of manic or hypomanic symptoms, and subsyndromal depressive symptoms are associated with significant impairment.
American Journal of PsychiatryThe McLean-Harvard First-Episode Mania Study: Prediction of Recovery and First Recurrence
465 Citations2003Mauricio Tohen, Carlos A. Zarate +6 more
Within 2-4 years of first lifetime hospitalization for mania, all but 2% of patients experienced syndromal recovery, but 28% remained symptomatic, only 43% achieved functional recovery, and 57% switched or had new illness episodes.
The Journal of Clinical PsychiatryMorbidity in 258 Bipolar Outpatients Followed for 1 Year With Daily Prospective Ratings on the NIMH Life Chart Method
409 Citations2003Robert M. Post, Kirk D. Denicoff +11 more
A majority of outpatients with bipolar illness, even with intense monitoring and treatment in specialty clinics, have a considerable degree of residual illness-related morbidity, including a 3-fold greater amount of time spent depressed versus time spent manic.
CNS DrugsSuicidal Behaviour in Bipolar Disorder
398 Citations2003Leonardo Tondo, Göran Isacsson +1 more
More can be done to improve treatment in major affective illnesses by application of current knowledge in a systematic fashion, with close and sustained clinical follow-up of patients at risk, hopefully with a resulting reduction of mortality rates.
Bipolar DisordersAntidepressants in bipolar disorder: the case for caution
391 Citations2003S. Nassir Ghaemi, Douglas J. Hsu +2 more
There is a strong rationale for a cautious approach to antidepressant use in bipolar disorder, consistent with, and perhaps even more strongly than, the APA guidelines, according to an interpretation of the evidence.
The Journal of Clinical PsychiatryThe Increasing Use of Polypharmacotherapy for Refractory Mood Disorders
313 Citations2000Mark A. Frye, Terence A. Ketter +5 more
Increasing numbers of medications in more recent NIMH cohorts were required to achieve the same degree of improvement at hospital discharge, suggesting more systematic approaches to the complex regimens required for treatment of patients with refractory mood disorder are clearly needed.
Journal of Clinical PsychopharmacologyAntipsychotic Drugs
308 Citations2005Veronica O’Keane, Anna Maria Meaney
The findings suggest that the high rates of osteoporosis associated with schizophrenia may result from hypogonadism secondary to antipsychotic-induced hyperprolactinemia, and that the prolactin-raising profile of antipsychotics drugs should be considered when choosing an antipsychosis drug.
American Journal of PsychiatryAntidepressant Treatment in Bipolar Versus Unipolar Depression
268 Citations2004S. Nassir Ghaemi, Klara J. Rosenquist +4 more
The findings suggest an unfavorable cost/benefit ratio for antidepressant treatment of bipolar depression, and modern antidepressants, in general, did not have lower rates of negative outcomes than tricyclic antidepressants.
American Journal of PsychiatryMultiple Versus Single Antipsychotic Agents for Hospitalized Psychiatric Patients: Case-Control Study of Risks Versus Benefits
249 Citations2004Franca Centorrino, Jessica L. Gören +4 more
Short-term treatment with multiple antipsychotics was associated with major increases in drug exposure, adverse events, and time in the hospital but with no apparent gain in clinical benefit, requiring further testing in controlled prospective studies.
EpilepsiaEpidemiology of Bipolar Disorders
204 Citations2005Michael Bauer, Andrea Pfennig
Research efforts to refine the diagnostic criteria of bipolar disorder aim at an earlier and complete recognition of the disease to provide appropriate pharmacological and nonpharmacological treatment early in the course of the illness to anticipate individual suffering, suicidal behavior, and increased socioeconomic costs for society.
The Journal of Clinical PsychiatryLithium Treatment and Risk of Suicidal Behavior in Bipolar Disorder Patients
175 Citations1998Leonardo Tondo, Ross J. Baldessarini +4 more
Suicidal behavior was strongly associated with prior suicide attempts, more time depressed, and younger age or recent onset and lithium maintenance was associated with marked reduction of life-threatening suicidal acts, the number of which sharply increased after discontinuing lithium.
Bipolar DisordersA prospective, longitudinal study of percentage of time spent ill in patients with bipolar I or bipolar II disorders
167 Citations2004Russell T. Joffe, Glenda MacQueen +2 more
Time spent in minor and subsyndromal mood states as well as with mania and depression in a cohort of well characterized bipolar I and II patients who were followed prospectively for an average of three years is examined.
American Journal of PsychiatryLower Switch Rate in Depressed Patients With Bipolar II Than Bipolar I Disorder Treated Adjunctively With Second-Generation Antidepressants
154 Citations2006Lori L. Altshuler, Trisha Suppes +10 more
It is suggested that depressed patients with bipolar II disorder are less vulnerable than those with bipolar I disorder to switch into hypomania/mania when treated with an antidepressant adjunctive to a mood stabilizer.
Harvard Review of PsychiatryPediatric-Onset Bipolar Disorder: A Neglected Clinical and Public Health Problem Gianni
150 Citations1995Luisina Faedda, Ross J. Baldessarini +4 more
Pediatric BPD is familial more often than is adult‐onset BPD, may be associated with a premorbid cyclothymic or hyperthymic temperament, and can be precipitated by antidepressant treatment.
The Journal of Clinical PsychiatryMisdiagnosed Patients With Bipolar Disorder
136 Citations2005Louis S. Matza, Krithika Rajagopalan +2 more
Misdiagnosed bipolar patients received inappropriate and costly treatment regimens involving overuse of antidepressants and underuse of potentially effective medications, suggesting one possible strategy for improving recognition of bipolar disorder among patients presenting with depressive symptoms.
The Journal of Clinical PsychiatryOptimizing the Detection of Bipolar II Disorder in Outpatient Private Practice
130 Citations2005Hagop S. Akiskal, Franco Benazzi
It is submitted that clinicians have the distinct advantage of intimate knowledge of their patients, which, coupled with the procedures outlined herein, can maximize the yield of BPII diagnoses.
The British Journal of PsychiatryLong-term clinical effectiveness of lithium maintenance treatment in types I and II bipolar disorders
130 Citations2001Leonardo Tondo, Ross J. Baldessarini +1 more
Based on overall affective morbidity, long-term lithium treatment in compliant patients without comorbid substance use disorder, though imperfect, remains effective, even in subgroups of supposedly poor prognosis.
Diabetes CareRecent Antihyperglycemic Prescribing Trends for U.S. Privately Insured Patients With Type 2 Diabetes
103 Citations2003Fredric J. Cohen, C. Neslusan +2 more
Overall, the prescribing trend has been away from monotherapy with insulins and sulfonylureas and toward combination therapies, presumably in attempts to reduce hypoglycemic symptoms and to achieve better glucose control.
CNS DrugsPolytherapy in Bipolar Disorder
92 Citations2006Daniel Lin, Hiram Mok +1 more
The evidence suggests that for acute mania a combination of lithium or valproate and an atypical antipsychotic is the most effective approach, with approximately 20% more patients responding to the combination than to monotherapy with any antimanic agent.
Harvard Review of PsychiatryIs Lithium Still Worth Using? An Update of Selected Recent Research
85 Citations2002Ross J. Baldessarini, Leonardo Tondo +2 more
No other treatment has performed as well as lithium in as many aspects of long-term care of bipolar disorder patients, and despite some risks and limitations, lithium remains the standard against which all proposed alternatives are compared.
The Canadian Journal of PsychiatryProphylaxis Latency and Outcome in Bipolar Disorders
72 Citations2003Christopher Baethge, Leonardo Tondo +5 more
American Journal of PsychiatryBipolar Depression in a Low-Income Primary Care Clinic
67 Citations2005Mark Olfson, Amar K. Das +7 more
Patients with bipolar depression were significantly more likely to have an alcohol use disorder and to report inpatient psychiatric care and antipsychotic treatment during the past month than patients with unipolar depression.
The World Journal of Biological PsychiatryBipolar disorder, antidepressants and induction of hypomania or mania. A systematic review
47 Citations2005H M Visser, Roos C. van der Mast
Overall, there is no strong evidence that use of antidepressants in bipolar disorder increases the risk of (hypo)mania, but there is an urgent need for adequate studies of sufficient size to determine the extent to which a mood stabilizer may be protective.
The Journal of Clinical PsychiatryLong-Term Combination Therapy Versus Monotherapy With Lithium and Carbamazepine in 46 Bipolar I Patients
46 Citations2005Christopher Baethge, Ross J. Baldessarini +7 more
Combining lithium with carbamazepine yielded substantial benefit but more adverse effects, and hospitalizations per year fell by 36.1%, and median time to recurrence nearly doubled during combination therapy.
Human Psychopharmacology Clinical and ExperimentalAntipsychotic drug use: McLean Hospital, 2002
44 Citations2005Franca Centorrino, Kate V. Fogarty +4 more
Major changes in antipsychotic treatment in recent years encouraged a survey of inpatient practice in 2002, compared with earlier samples, which indicated an improvement in the quality of treatment.
Child Care Health and DevelopmentPrescribing practices of psychiatrists and primary care physicians caring for children with mental illness
30 Citations2006Ilan Harpaz‐Rotem, Robert A. Rosenheck
Collaborative care models in which non-physician mental health specialists and PCPs work together may increase the availability of effective mental health services for youths.