A Systematic Review of Complex Polypharmacy in Bipolar Disorder

Abstract

Early Career Psychiatrists: Review Article CME BackgroundArticles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results. To obtain credit, read the article, correctly answer the questions in the Posttest, and complete the Evaluation. A $10 processing fee will apply. CME ObjectiveAfter studying this article, you should be able to:• Regularly weigh risks versus benefits of the components of a complex pharmacotherapy regimen for patients with bipolar disorder Accreditation StatementThe CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

“Addressing the core trait of bipolar disorder”: A concept analysis of mood‐stabilizing drugs

“…Helping patients achieve remission on monotherapy is another argument for keeping the concept. A medication truly treating bipolar disorder diminishes the need of employing extensive polypharmacy, each targeting some symptoms or phases of the disease 40 …”

“…A medication truly treating bipolar disorder diminishes the need of employing extensive polypharmacy, each targeting some symptoms or phases of the disease. 40 This debate on properties of mood-stabilizing drugs is now decades old. Notwithstanding, some categories were based on the perspectives of only a few authors.…”

Fourteen-year trends in prescribing patterns for patients with bipolar mania discharged from a public psychiatric hospital in Taiwan

“…Simple polypharmacy was defined as being prescribed 2 different mood stabilizers (lithium, valproate, or carbamazepine) or a mood stabilizer plus any antipsychotics at discharge. Complex polypharmacy, as defined in prior studies, [18,19] was characterized by the prescription of 3 or more medications from the following options: lithium, valproate, carbamazepine, and any antipsychotics. In accordance with recommendations from previous research, [20] medications such as benzodiazepines and other sedative-hypnotics (e.g., zolpidem and zopiclone), which are not primarily recognized as core treatment modalities for bipolar disorder symptoms, were excluded from the analysis.…”

“…[36] Third, over the past 3 decades, the US FDA has approved multiple psychotropic drugs for bipolar disorder treatment, expanding the prescribing options for psychiatrists. [37] Fourth, psychiatrists may feel safer adding a new psychotropic agent than switching from or discontinuing an original drug with inadequate treatment response. [38]…”

“…Our findings may reflect the prescribing trends for long-term maintenance treatment in such patients. Finally, the definition of complex polypharmacy in bipolar patients has been inconsistent across studies, [18][19][20] thereby limiting the ability to make comparisons with other research.…”