Abstract
Using data from the US care system over 20 years, Rhee and colleagues (1) reported in the American Journal of Psychiatry (July 2020) that, among outpatients with Bipolar Disorder (BD), the prescriptions of second-generation antipsychotics (SGAs) massively increased (from 12.4% of BD outpatient in the 1997–2000 period to 51.4% in the 2013–2016 period), while the prescriptions of lithium and anticonvulsants decreased (from 62.3% of BD patients in the 1997–2000 period to 26.4% in the 2013–2016 period). The use of antidepressants, whose efficacy in bipolar depression is limited (2), constantly rose during the same period, these being often prescribed without any mood stabilizer (40.9% in the 2013–2016 period) in about half of the visits.
Highlights
THE GROWING USE OF SECOND GENERATION ANTIPSYCHOTICS IS QUESTIONABLE. This shift from lithium/anticonvulsants to second-generation antipsychotics (SGAs) prescriptions is observed in Europe [3, 4]
While formally approved in Bipolar Disorder (BD), the rising use of SGAs is alarming as it is associated with metabolic syndrome [5]
Metabolic syndrome, which is associated with a 2-fold higher rate of cardiovascular outcomes and a 1.5fold higher all-cause mortality rate, affects 37% of patients with BD [6]
Summary
Using data from the US care system over 20 years, Rhee and colleagues [1] reported in the American Journal of Psychiatry (July 2020) that, among outpatients with Bipolar Disorder (BD), the prescriptions of second-generation antipsychotics (SGAs) massively increased (from 12.4% of BD outpatient in the 1997–2000 period to 51.4% in the 2013–2016 period), while the prescriptions of lithium and anticonvulsants decreased (from 62.3% of BD patients in the 1997–2000 period to 26.4% in the 2013–2016 period). The use of antidepressants, whose efficacy in bipolar depression is limited [2], constantly rose during the same period, these being often prescribed without any mood stabilizer (40.9% in the 2013–2016 period) in about half of the visits
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