A study in Scotland has looked at medicines given to people with bipolar disorder from 2009 to 2016 to see if they has been any changes in describing patterns.
People with bipolar experience extreme moods with episodes of feeling low and then feeling really high. Treatment can be complex and usually takes place in hospital rather than with a GP. The recommended long-term treatment is lithium, a mood stabiliser. Antidepressants may also be used as well if the patient suffers from depression. Antipsychotic medicines are often used in the management of a sudden episode of mania, or may be used as part of longer-term care.
The study found that more patients were not being prescribed lithium but were given antidepressants which can make their condition worse. The use of antidepressants alone without a mood stabiliser like lithium may worsen or create episodes of mania in people with bipolar.
The researchers who carried out the study were from the University of Glasgow and the NHS Greater Glasgow and Clyde. The researchers used two Scottish NHS databases, the first allowed them to identify people with a diagnosis of bipolar disorder and the second allowed them to see what drugs they had been prescribed between 2009 and 2016. This resulted in a group of 23,135 patients with the most common type of bipolar disorder who had been prescribed medication at least once during the study time.
The study looked at six categories of medicine people were prescribed for a period of at least 3 months:
- hypnotics and anti-anxiety drugs
- antipsychotics
- lithium
- sodium valproate (an anti-epileptic drug)
- other anti-epileptic drugs
- antidepressants
They also looked into how many one patient was prescribed to in these categories.
25% of people form of treatment was antidepressants which is the most common treatment. 12.9% of people used antipsychotics and 6.9% of people used hypnotics or anti-anxiety drugs. Lithium was the sixth most common prescribed form of treatment with 5.9% receiving it.
Daniel Smith, a professor of psychiatry at Glasgow University who led the study, said: “These findings are a matter for concern.
“They suggest that many people in Scotland with bipolar disorder may not be getting the best medication treatment.”
He added: “Specifically, we found that there was a gradual decline in the prescribing of lithium and a pattern of consistently high prescribing of antidepressants on their own.
“For many patients, the use of antidepressants in bipolar disorder runs the risk of making the long-term course of the illness worse, rather than better.
“It’s not clear why psychiatrists are prescribing less lithium – it may be because of changes in clinical training or because of effective marketing of medications like antipsychotics.”
Alison Cairns, chief executive of Bipolar Scotland, said: “We’ve been concerned for some time by the number of people being prescribed antidepressants without an accompanying mood stabiliser.
“We urge everyone to have a constructive discussion with their clinician to ensure they’re receiving the best medication possible and to know why they’re taking it. We strongly endorse patient-clinician partnerships.”
Prof Allan Young, president of the British Association of Psychopharmacology, added: “Patients are most frequently prescribed a treatment (antidepressants) which has little if any evidence of benefit in bipolar disorder and only rarely prescribed the treatment with the most evidence of benefit, lithium.
“Doctors should strive to improve prescribing practice and bring this into line with the scientific evidence and treatment guidelines.”
The study raises concerns that the management of bipolar disorder may be out of line with best practice. The prescription of lithium was low, lithium was reserved for people who did not respond to other drugs because of concerns about toxic side effects and the need for frequent blood tests. Many people with bipolar disorder may have tried different drugs or combinations of drugs before settling on what suits them best.
