Yian Lin1, Ramin Mojtabai1, Fernando S Goes2, Peter P Zandi3. 1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. 2. Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States. 3. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States. Electronic address: pzandi1@jhu.edu.
Abstract
BACKGROUND: Studies have shown that rates of lithium use for bipolar disorder in the United States declined through the 1990s as other mood stabilizing anticonvulsants and second-generation antipsychotics (SGAs) became more popular. We examined trends of medications for bipolar disorder from 1996 to 2015. METHODS: Twenty years of data from the National Ambulatory Medical Care Survey (NAMCS) were used. Weighted percentages of reported use of lithium, anticonvulsants, SGAs and antidepressants were calculated over two-year intervals. Logistic regression was used to examine factors related to polytherapy. RESULTS: Reported use of lithium declined from 38.1% (95%CI: 29.8% - 46.3%) in 1996-97 to 14.3% (95%CI: 10.6% - 18.1%) in 2006-07 and has remained stable since. During this time, reports of SGAs more than doubled. SGAs and/or anticonvulsants were reported in 75.4% (95%CI: 69.5% - 81.3%) of visits with bipolar diagnoses in 2014-15. Polytherapy increased by approximately 3% every two years and in 2014-15 occurred in over 30% of visits. Antidepressants were reported in 40-50% of visits, but their reported use without other mood stabilizers decreased from 18.2% (95%CI: 11.7% - 24.8%) in 1998-99 to 7.5% (95%CI: 4.2% - 10.9%) in 2014-15. LIMITATIONS: The sample had limited power to study the effect of individual medications or the potential for differing effects in certain sub-groups of patients. CONCLUSIONS: This study further documents the declining use of lithium for bipolar disorder, and corresponding increase in use of anticonvulsants and SGAs, despite the fact that lithium is typically recommended as a first line therapy for bipolar disorder.
BACKGROUND: Studies have shown that rates of lithium use for bipolar disorder in the United States declined through the 1990s as other mood stabilizing anticonvulsants and second-generation antipsychotics (SGAs) became more popular. We examined trends of medications for bipolar disorder from 1996 to 2015. METHODS: Twenty years of data from the National Ambulatory Medical Care Survey (NAMCS) were used. Weighted percentages of reported use of lithium, anticonvulsants, SGAs and antidepressants were calculated over two-year intervals. Logistic regression was used to examine factors related to polytherapy. RESULTS: Reported use of lithium declined from 38.1% (95%CI: 29.8% - 46.3%) in 1996-97 to 14.3% (95%CI: 10.6% - 18.1%) in 2006-07 and has remained stable since. During this time, reports of SGAs more than doubled. SGAs and/or anticonvulsants were reported in 75.4% (95%CI: 69.5% - 81.3%) of visits with bipolar diagnoses in 2014-15. Polytherapy increased by approximately 3% every two years and in 2014-15 occurred in over 30% of visits. Antidepressants were reported in 40-50% of visits, but their reported use without other mood stabilizers decreased from 18.2% (95%CI: 11.7% - 24.8%) in 1998-99 to 7.5% (95%CI: 4.2% - 10.9%) in 2014-15. LIMITATIONS: The sample had limited power to study the effect of individual medications or the potential for differing effects in certain sub-groups of patients. CONCLUSIONS: This study further documents the declining use of lithium for bipolar disorder, and corresponding increase in use of anticonvulsants and SGAs, despite the fact that lithium is typically recommended as a first line therapy for bipolar disorder.
Authors: Vanessa W S Ng; Kenneth K C Man; Le Gao; Esther W Chan; Edwin H M Lee; Joseph F Hayes; Ian C K Wong Journal: Pharmacoepidemiol Drug Saf Date: 2021-07-08 Impact factor: 2.732