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RESEARCH SUGGESTS OUTPATIENT TREATMENT OF BIPOLAR DISORDER MAY BE INADEQUATE
(New York, NY)—June 27, 2002—Bipolar (or manic depressive) patients may be suffering the consequences of poor treatment by not receiving medications that have been proven effective in substantially reducing the manic effects of the illness, which can be both chronic and debilitating. Although there are existing guidelines that outline effective treatment regimens for bipolar patients, researchers have found that outpatient treatment by psychiatrists is frequently inadequate. As reported in the June issue of the American Journal of Psychiatry, researchers at the New York State Psychiatric Institute analyzed eight years of data collected by the National Ambulatory Medical Care Survey in order to identify prescribing patterns for the medical treatment of bipolar patients in an office setting. They found that psychiatrists treating in an office setting often prescribed antidepressants (generally an SSRI or selective serotonin reuptake inhibitors) for bipolar patients without a mood stabilizer such as lithium or valproic acid. The researchers, led by Dr. Carlos Blanco of the Anxiety Disorders Unit at the Institute, evaluated a total of 865 visits from two separate surveys, from 1992-1995 and from 1996-1999. “Over one-third of the samples from both time periods received no mood stabilizer,” the authors write. “In both periods, patients were prescribed an antidepressant, generally an SSRI…About one-half of the visits during both periods that included an antidepressant prescription did not include prescription of a mood stabilizer.” Because of the risk of triggering mania, doctors often prescribe a mood stabilizer to be used in conjunction with the antidepressant. Dr. Blanco and his colleagues did, however, note a change in the types of medications given from one survey period to the next. Lithium prescriptions, for example, decreased from about 51 percent during the 1992-95 period to 30 percent during the 1996-99 period. Prescriptions for valproic acid more than doubled from 11 percent to just over 26 percent. “Although the reasons for this change are unknown,” said Dr. Blanco, “they are probably related to increased awareness among psychiatrists of the availability of several agents for the treatment of bipolar disorder.” However, the information available in the survey suggested that, in many cases, the medications prescribed were not determined by the clinical characteristics of the patients. Further study may be needed to investigate the inconsistencies between published guidelines and current practice, and how psychiatrists go about making treatment decisions. The researchers could not determine, for example, whether a poor response to mood stabilizers in the past or refusal on the part of the patient may have been a factor in the failure to prescribe this type of medication.
Contact: Dacia Morris |