Polypharmacy in Outpatients with Bipolar Disorder: Associated Factors and Treatment Characteristics in Türkiye

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Objective: Polypharmacy is frequently used in the treatment of the bipolar disorder. We aimed to investigate polypharmacy rates, associated factors, and the types of drugs preferred in treatment among outpatients with bipolar disorder. 
 Method: A total of 209 bipolar disorder patients attending an outpatient psychiatry clinic were included in this study. Drug types, active substances, and combination forms were examined. 
 Results: The rate of polypharmacy among bipolar outpatients was 79.40%. Antipsychotics were the most frequently preferred drug for the treatment. The most commonly used antipsychotic was quetiapine, whereas the mood stabilizer was sodium valproate and the antidepressant was paroxetine. The most common form of treatment for bipolar disorder was the combined use of a mood stabilizer and an antipsychotic. 
 Conclusion: In contrast to treatment guidelines, polypharmacy has virtually become a standard in the treatment of bipolar disorder. It appears that the adoption of polypharmacy in treatment will persist for various reasons. As such, there is a need to develop new guidelines to guide psychiatrists in determining the patient groups and combinations in which combination therapy will be preferred. Moreover, interventions are needed to minimize the possible side effects, and risk of drug-drug interactions related to the use of multiple drugs, determine the benefit/harm ratio and reduce unnecessary psychotropic drug use.