Abstract
Objectives: To examine longitudinal patterns of complexity, continuity, and initiation of treatment for youth diagnosed with bipolar disorder. Additionally, we explore bipolar diagnosis stability and its relationship to observed treatment patterns. Methods: A cohort of 426 privately insured youth (ages 6–18) diagnosed with bipolar disorder was identified from the 2000–2001 Thomson/Medstat-MarketScan® database. Medication complexity was defined as number of different psychotropic medication classes dispensed during a 6-month period following a new treatment episode of bipolar disorder. Treatment continuity was examined over a 6-month follow-up period, specifically focusing on mood stabilizing medications and antidepressant monotherapy. Predictors of complexity and continuity were investigated. Results: Fifty-five percent of youth received more than one and 25% received three or more different types of psychotropic medication classes during follow-up. This was contrasted with several youth having no prescription fills (21%) and 31% discontinuing mood stabilizing medication. Youth with a stable bipolar diagnosis were more likely to have continuity of mood stabilizing prescriptions (OR: 4.05), but also greater psychotropic medication complexity. Age, health status/comorbidity, and being in a managed care plan were also related to complexity and continuity of psychotropic medication class regimens. Conclusions: More evidence is needed on the causal patterns leading to increased psychotropic medication complexity and continuity and how diagnosis of bipolar disorder may drive treatment patterns.
Highlights
The pharmacological management of children and adolescents with bipolar disorder is widely recognized as challenging and complex
Since the medication name is not recorded on the pharmacy claims file, the Thomson-Medstat MarketScan database was linked to the Multum lexicon database using the National Drug Code (NDC) to extract the drug name (Mumford, 2008)
Many youth who receive two or more diagnoses of bipolar disorder and/or are hospitalized for that diagnosis do not continue to receive treatment for bipolar disorder over the 6-month period following diagnosis. Those who do receive a continuous diagnosis of bipolar disorder are more likely to receive continuous pharmacological treatment for bipolar disorder, but are more likely to have complex regimes with multiple psychotropic agents/medications
Summary
The pharmacological management of children and adolescents with bipolar disorder is widely recognized as challenging and complex. The Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) established guidelines that advise treating each disorder separately because comorbidity worsens the prognosis for youth with bipolar disorder (Kowatch and DelBello, 2005). This is complicated because common treatments for comorbid disorders may include antidepressants and stimulants which the guidelines suggest may “exacerbate mania.”. It is recommended to use antidepressants in combination with a mood stabilizing medication These issues may be even more complicated for younger children who tend to have a less clear presentation of bipolar disorder (Ryan et al, 1987; Biederman et al, 2005; Wozniak, 2005; Goodwin and Jamison, 2007)
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