Introduction: Combination treatment, rather than monotherapy, is prevalent
in the treatment of subjects with bipolar disorder, probably due to the com
plex and phasic nature of the illness. In general. prescription patterns ma
y be influenced by the demographic characteristics of patients as well. We
evaluated prescription patterns and the influence of demographic variables
on these patterns in a voluntary registry of subjects with bipolar disorder
.
Methods: A subset of data from a larger voluntary registry was extracted fo
r demographic variables and psychotropic medication use that had been repor
ted in the month prior to registration by ambulatory, non-hospitalized subj
ects with bipolar I disorder in 1995/96 (n = 457).
Results: Among the thymoleptic agents. lithium was prescribed in over 50% o
f subjects. valproate in approximately 40%, and carbamazepine in 11% of sub
jects. Eighteen percent of subjects had no prescription for thymoleptic age
nts. Nearly one-third of all subjects were receiving antipsychotic agents.
of whom two-thirds were receiving the traditional neuroleptic agents. More
than half of all subjects were receiving concomitant antidepressants, of wh
om nearly 50% received the SSRI antidepressants and nearly 25%:, received b
uproprion. Approximately 40%: of subjects received benzodiazepines. Only 18
% of subjects received monotherapy. and nearly 50% received three or more p
sychotropic agents, In general, no associations were noted between demograp
hic parameters including age. gender, marital or educational status,:ind ps
ychotropic prescriptions.
Conclusion: Consistent with the anecdotal reports, these data confirm that
combination treatment is Far more common than monotherapy. Demography appea
rs to have a minimal impact on cross-sectional prescription patterns in sub
jects with bipolar disorder. Given that combination treatments are the rule
rather than the exception, we should strive to achieve rational. yet pragm
atic, treatment guidelines and algorithms to minimize the risks while maxim
izing the benefits of these combination treatments for patients with bipola
r disorder.