Abstract
ObjectivesTo determine changes in prescribing patterns in primary care of antipsychotic and mood stabiliser medication in a representative sample of patients with bipolar disorder in the United Kingdom over a fifteen year period and association with socio-demographic factors.MethodsWe identified 4700 patients in the Health Improvement Network (THIN) primary care database, who had received treatment for bipolar disorder between 1995 and 2009. The proportion of time for which each individual was prescribed a particular medication was studied, along with variation by sex, age and social depravation status (quintiles of Townsend scores). The number of drugs an individual was taking within a particular year was also examined.ResultsIn 1995, 40.6% of patients with bipolar disorder were prescribed a psychotropic medication at least twice. By 2009 this had increased to 78.5% of patients. Valproate registered with the greatest increase in use (22.7%) followed by olanzapine (15.7%) and quetiapine (9.9%). There were differences by age and sex; with young (18–30 year old) women having the biggest increase in proportion of time on medication. There were no differences by social deprivation status. By 2009, 34.2% of women of childbearing age were treated with valproate.ConclusionsLithium use overall remained relatively constant, whilst second generation antipsychotic and valproate use increased dramatically. Changes in prescribing practice preceded published trial evidence, especially with the use of second generation antipsychotics, perhaps with inferences being made from treatment of schizophrenia and use of first generation antipsychotics. Women of childbearing age were prescribed valproate frequently, against best advice.
Highlights
Bipolar affective disorder is one of the commonest causes of disability worldwide, especially within the 15–44 age group [1]
Study design and setting We carried out a retrospective cohort study of individuals in primary care with a diagnosis of bipolar disorder using The Health Improvement Network (THIN) primary care database
To aid analysis treatment sessions were defined in 3 levels: Level 1 – any antipsychotic prescription or any mood stabiliser prescription, Level 2 – class of treatment namely first generation antipsychotic (FGA), second generation antipsychotic (SGA), anticonvulsant, or lithium, Level 3 – individual antipsychotic or mood stabiliser medications
Summary
Bipolar affective disorder is one of the commonest causes of disability worldwide, especially within the 15–44 age group [1]. Most treatment guidelines attempt to inform complex treatment decisions based on clinical trial findings. Patients are seldom as straightforward as those recruited to trials, in terms of illness characteristics, diagnostic heterogeneity, labile symptomatic presentations of the illness, and comorbidity [3]. Whereas most treatment trials have duration of months, the management of bipolar disorder is a lifelong effort to reduce symptoms and maximize quality of life. Used medications for maintenance treatment of bipolar disorder are mood stabilisers including lithium and anticonvulsants (valproate, carbamazepine, lamotrigine), first generation antipsychotics (FGAs), such as chlorpromazine and haloperidol, and second generation antipsychotics (SGAs), such as olanzapine and quetiapine
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