Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study

Bjørklund, Louise; Horsdal, Henriette Thisted; Mors, Ole; Østergaard, Søren Dinesen; Gasse, Christiane

doi:10.1017/neu.2015.52

Cited by 44 publications

(54 citation statements)

References 41 publications

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“…They found a proportion of patients lacking a mood-stabilizer of 20.5% in 1997 and 12.1% in 2012 (Bjørklund et al, 2015). We cannot make a direct comparison between our results and theirs, since our study only included women between age 15 and 55.…”

Section: Antidepressant Use Without a Mood-stabilizermentioning

confidence: 64%

“…Compared to the overall patterns of use, the women who gave birth in 2011 and 2012 showed a higher use of antidepressants, atypical antipsychotics and anticonvulsants, which follows the trends in psychotropic drug utilization in all Danish patients with bipolar disorder over time (Bjørklund et al, 2015).…”

Section: Psychopharmacological Drug Utilization Patternsmentioning

confidence: 70%

“…This may be due to an increased use of other mood-stabilizing agents that specifically target the predominant polarity of the mood disorder (Bjørklund et al, 2015;Grunze et al, 2013;Larsen et al, 2015).…”

Section: Psychopharmacological Drug Utilization Patternsmentioning

confidence: 99%

“…If needed, multiple mood-stabilizers can be combined. Antidepressants are often used (Bjørklund et al, 2015), but the effects are much debated in both acute and long-term treatment (Frye, 2011;Grunze et al, 2013). Current guidelines discourage antidepressant monotherapy and recommend concomitant use of a mood-stabilizer because of the potential risk for treatment-emergent affective switches.…”

Section: Introductionmentioning

confidence: 99%

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Psychopharmacological drug utilization patterns in pregnant women with bipolar disorder – A nationwide register-based study

Broeks

Horsdal

Ingstrup

et al. 2017

Journal of Affective Disorders

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Section: Antidepressant Use Without a Mood-stabilizermentioning

confidence: 64%

Section: Psychopharmacological Drug Utilization Patternsmentioning

confidence: 70%

Section: Psychopharmacological Drug Utilization Patternsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Psychopharmacological drug utilization patterns in pregnant women with bipolar disorder – A nationwide register-based study

Broeks

Horsdal

Ingstrup

et al. 2017

Journal of Affective Disorders

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“…[1][2][3] Acceptance of this strategy which promises better efficacy 4 despite a higher potential of adverse events 5,6 is reflected in increasing prescription trends. 7 Many pharmacokinetic drug-drug interactions (DDIs) have been identified by therapeutic drug monitoring (TDM) as TDM databases enable evaluation of pharmacokinetic DDIs in a representative population to get an insight into the safety and tolerability of combined psychopharmacological treatment. Pharmacokinetic interactions in phase 1 drug metabolism, such as inhibition or induction of cytochrome P450 (CYP) activity, are the most important mechanisms of clinical DDIs.…”

mentioning

confidence: 99%

Pharmacokinetic Drug-Drug Interactions of Mood Stabilizers and Risperidone in Patients Under Combined Treatment

Schoretsanitis¹,

Haen²,

Gründer³

et al. 2016

J Clin Psychopharmacol

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Background: The combination of anticonvulsant mood stabilizers with antipsychotic drugs may lead to clinically relevant drug-drug interactions. The objective of the study was to identify pharmacokinetic interactions of different mood stabilizers on the metabolism of risperidone (RIS) under natural conditions.Methods: A large therapeutic drug monitoring database containing plasma concentrations of RIS and its metabolite 9-hydroxy-RIS (9-OH-RIS) of 1,584 adult patients was analyzed. Four groups (n = 1,072) were compared: a control group without a potentially cytochrome interacting comedication (R 0 , n = 852), a group comedicated with valproate (VPA) (R VPA , n = 153), a group comedicated with lamotrigine (LMT) (R LMT , n = 46), and a group under concomitant medication with carbamazepine (CBZ) (R CBZ , n = 21). Dose-adjusted plasma concentrations (C/D ratio) for RIS, 9-OH-RIS and active moiety (AM) (RIS + 9-OH-RIS), as well as metabolic ratios (RIS/9-OH-RIS) were computed.Results: Groups did not differ with regard to the daily dosage (P = 0.46).Differences were detected for the distributions of the C/D ratios for RIS, 9-OH-RIS and AM (P = 0.003, P < 0.001 and P < 0.001, respectively). Differences remained significant after conducting a Bonferroni correction (P = 0.0125). Pairwise comparisons of the concomitant medication groups with the control group revealed significant differences; RIS C/D ratios were significantly higher in the VPA and the LMT group than in the control group (P = 0.013; P = 0.021). However, these differences did not remain significant after Bonferroni correction. In contrast, CBZ-treated patients showed lower dose-adjusted plasma concentrations of 9-OH-RIS (P < 0.001) as well as the AM (P < 0.001) than the control group; this difference survived the Bonferroni correction. Conclusions:The data give evidence for pharmacokinetic interactions between RIS and different anticonvulsant mood stabilizers. Carbamazepine decreased serum concentrations of 9-OH-RIS and the AM when compared with the control group. In case of VPA and LMT, findings were less significant; hints for a weak RIS metabolism inhibition by LMT of unclear clinical significance were found.Key Words: therapeutic drug monitoring, risperidone, carbamazepine, valproic acid, lamotrigine cytochrome P450, interaction, pharmacokinetics (J Clin Psychopharmacol 2016;36: 00-00) G uidelines worldwide recommend the coadministration of second-generation antipsychotics as augmentative therapy to mood stabilizers or vice versa in the treatment of bipolar disorders, especially for the treatment of manic episodes.1-3 Acceptance of this strategy which promises better efficacy 4 despite a higher potential of adverse events 5,6 is reflected in increasing prescription trends. 7 Many pharmacokinetic drug-drug interactions (DDIs) have been identified by therapeutic drug monitoring (TDM) as TDM databases enable evaluation of pharmacokinetic DDIs in a representative population to get an insight into the safety and tolerability of combined psychopharmacological ...

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Lithium Use During Pregnancy in 14 Countries

Wittström,

Cesta,

Bateman

et al. 2024

JAMA Netw Open

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ImportanceIn pregnancy, the benefits of lithium treatment for relapse prevention in psychiatric conditions must be weighed against potential teratogenic effects. Currently, there is a paucity of information on how and when lithium is used by pregnant women.ObjectiveTo examine lithium use in the perinatal period.Design, Setting, and ParticipantsThis cohort study used individual-level data of pregnancies from January 1, 2000, to December 31, 2021, in Australia, Denmark, Finland, Germany, Hong Kong, Iceland, Israel, New Zealand, Norway, South Korea, Sweden, Taiwan, the UK, and 2 cohorts in the US. Analyses were performed from September 1 to November 30, 2023.ExposuresThe prevalence of lithium use as the proportion of pregnancies with at least 1 prescription fill or prescription within 3 months before pregnancy until childbirth was estimated using a common protocol. Lithium use during pregnancy by trimester and in the 3 months before and after pregnancy was examined.Main Outcomes and MeasuresComparison of prevalence between the first and last 3-year periods of available data.ResultsAmong 21 659 454 pregnancies from all collaborating sites, the prevalence of lithium use ranged from 0.07 per 1000 pregnancies in Hong Kong to 1.56 per 1000 in the US publicly insured population. Lithium use increased per 1000 pregnancies in 10 populations (Australia [0.60 to 0.74], Denmark [0.09 to 0.51], Finland [0.10 to 0.29], Iceland [0.24 to 0.99], Israel [0.25 to 0.37], Norway [0.24 to 0.47], South Korea [0.30 to 0.44], Sweden [0.42 to 1.07], the UK [0.07 to 0.10], and Taiwan [0.15 to 0.19]), remained stable in 4 populations (Germany [0.17 to 0.16], Hong Kong [0.06 to 0.06], and the publicly [1.50 to 1.34] and commercially [0.38 to 0.36] insured US populations), and decreased in 1 population (New Zealand [0.54 to 0.39]). Use of lithium decreased with each trimester of pregnancy, while prevalence of postpartum use was similar to prepregnancy levels. The proportion of lithium use in the second trimester compared with the prepregnancy period ranged from 2% in South Korea to 80% in Denmark.Conclusions and RelevancePrevalence of lithium use in pregnant women over the past 2 decades varied markedly between populations. Patterns of use before, during, and after pregnancy suggest that many women discontinued lithium use during pregnancy and reinitiated treatment after childbirth, with large variations between countries. These findings underscore the need for internationally harmonized guidelines, specifically for psychiatric conditions among pregnant women that may benefit from lithium treatment.

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Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study

Abstract: The results show an increase in the proportion of patients with bipolar disorder being treated with antidepressants in the period from 1997 to 2012. However, in accordance with international treatment guidelines, the extent of antidepressant monotherapy decreased during the same period.

Cited by 44 publications

References 41 publications

Psychopharmacological drug utilization patterns in pregnant women with bipolar disorder – A nationwide register-based study

Psychopharmacological drug utilization patterns in pregnant women with bipolar disorder – A nationwide register-based study

Pharmacokinetic Drug-Drug Interactions of Mood Stabilizers and Risperidone in Patients Under Combined Treatment

Lithium Use During Pregnancy in 14 Countries

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