Patterns of psychotropic drug prescription for US patients with diagnoses of bipolar disorders
Patterns of psychotropic drug prescription for US patients with diagnoses of bipolar disorders
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DOI：
10.1176/appi.ps.58.1.85
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发表时间：
2007-01-01
影响因子：
3.8
通讯作者：
Hennen, John
中科院分区：
文献类型：
--
作者：
Baldessarini, Ross J.;Leahy, Leslie;Hennen, John
双相情感障碍是常见的主要疾病，具有高发病率、合并症、残疾率和死亡率。越来越多的精神药物被用于治疗双相情感障碍，通常是标签外的，未经测试的，复杂的组合。研究方法：为了量化精神药物类别的使用率，这项研究使用了2002-2003年美国国家市场扫描研究数据库，以确定7,760人与ICD-9双相情感障碍亚型。生存分析用于估计初始单药治疗增加、改变或停止的时间。结果如下：最常见的第一类药物是抗抑郁药（50%的患者），其次是情绪稳定剂（25%：抗惊厥药，17%，锂，8%），镇静剂（15%）和抗精神病药（11%）。在研究中点，只有44%的患者接受单药治疗。接受单药治疗的患者按初始药物处方和患者百分比（双相I型和双相11型）进行排名：抗抑郁药（55%和65%）、锂（51%和41%）、抗精神病药（32%和31%）、抗惊厥药（28%和29%）和镇静剂（28%和25%）。增加另一种精神药物的中位时间是改变初始治疗的中位时间的2.5倍（16.4周对40.9周），并且停止治疗的情况很少。25%的患者治疗发生任何改变的中位周数如下：锂剂，29周;抗抑郁药，13周;抗惊厥药，13周;抗精神病药，13周;镇静剂，9周。结论：抗抑郁药是首选药物，是情绪稳定剂的两倍。锂的持续时间长于其他情绪稳定剂的单药治疗。至增强的时间远短于至改变或停止的时间。
Bipolar disorders are prevalent major illnesses with high rates of morbidity, comorbidity, disability, and mortality. A growing number of psychotropic drugs are used to treat bipolar disorder, often off-label and in untested, complex combinations. Methods: To quantify utilization rates for psychotropic drug classes, this study used the 2002-2003 U.S. national MarketScan research databases to identify 7,760 persons with ICD-9 bipolar disorder subtypes. Survival analysis was used to estimate times until initial monotherapies were augmented, changed, or discontinued. Results: The most commonly prescribed first drug class was antidepressants (50% of patients), followed by mood stabilizers (25%: anticonvulsants, 17%, and lithium, 8%), sedatives (15%), and antipsychotics (11%). At study midpoint only 44% of patients were receiving monotherapy. Those receiving monotherapy were ranked by initial drug prescribed and percentage of patients (bipolar I and bipolar 11): antidepressants (55% and 65%), lithium (51% and 41%), antipsychotics (32% and 31%), anticonvulsants (28% and 29%), and sedatives (28%, 25%). Median time to adding another psychotropic was 2.5-times less than median time to changing the initial treatment (16.4 compared with 40.9 weeks), and stopping was rare. Median weeks until therapy was changed in any way for 25% of patients was as follows: lithium, 29 weeks; antidepressants, 13; anticonvulsants, 13; antipsychotics, 13; and sedatives, 9. Conclusions: Antidepressants were the first-choice agent twice as often as mood stabilizers. Lithium was sustained longer than monotherapy with other mood stabilizers. Time to augmentation was much shorter than time to change or discontinuation.