The Drug Burden of Bipolar Disorder

drugBeing diagnosed with bipolar disorder often brings about significant medication responsibility for patients.[1] According to Brown University researchers Lauren Weinstock, Ph.D. and colleagues, more than one-third of patients with bipolar disorder take four or more psychiatric medicines daily.

Weinstock and colleagues conducted a study that followed 230 patients with bipolar I disorder, all of whom had been admitted to a Rhode Island psychiatric hospital due to symptom severity. The participants were on an average of six different medicines, as many were also taking medicines for other medical conditions, such as cardiovascular disease and/or metabolic disorders.

According to Weinstock, “The study quantifies a difficult outcome for many patients with this difficult-to-treat disorder. The high rate of complex polypharmacy reflects the enormous challenge of symptom management that we currently face for bipolar disorder.”

Patients with bipolar disorder often accumulate a large number of prescriptions. Each have their own side effects, many with unknown interactions, as well as high costs, that often result in patients to discontinue their use against the advice of their prescribing doctor.

“Without many treatment alternatives, this is where we are as a field,” said Weinstock. “It is important for us to advance science and treatment of bipolar disorder so that this medication burden can be minimized for our patients.”

Weinstock and colleagues compiled data from the 2010 hospital admission records of patients. As they wished to measure what was happening in a routine practice, their only inclusion criteria were that the patients were 18 years or older and were diagnosed with bipolar I disorder. They found that patients were taking an average of 3.3 psychotropic drugs, with an average of 5.9 drugs overall. While one in five patients were not taking any psychotropic drugs, more than half were taking three or more, and more than a third were taking four or more. As no clinical trial of bipolar medicines has ever tested more than two drugs in combination, prescribing three or four exceeds the practices supported by the field.

According to Weinstock, “By definition, that is not evidence-based treatment. No prior studies had looked at the total medication burden, rather than just that of psychotropics. It is important to do so because cardiometabolic diseases, in particular, are often concurrent with bipolar disorder. Among the 230 patients in the study, for example, about half had such medical problems.”

In the end, the study still points out an area in need of improvement. Weinstock and colleagues wrote: “This increased reliance on polypharmacy does not appear to be contributing to decreased rates of illness chronicity or functional impairment in bipolar disorder.”

[1] Nauert, R. (2014). Assessing the Drug Burden of Bipolar Disorder. Psych Central. Retrieved on February 5, 2014, from http://psychcentral.com/news/2014/02/05/burden-of-bipolar-disorder/65469.html

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