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Mono- and combination drug therapies in hospitalized patients with bipolar depression. Data from the European drug surveillance program AMSP

DOI: 10.1186/1471-244x-12-153

Keywords: AMSP, Bipolar depression, Bipolar disorder, Combination therapy, Drug surveillance, Guidelines, Pharmacotherapy, Prescription, Psychotropic drugs, Antidepressants

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Abstract:

The prescriptions of psychotropic drugs were investigated of all in-patients with bipolar depression (n?=?2246; time period 1994–2009) from hospitals participating in the drug surveillance program AMSP. For the drug use in 2010, 221 cases were analysed additionally.From 1994 to 2009, 85% of all patients received more than one class of psychotropic substances: 74% received antidepressants in combination therapy, 55% antipsychotics, 48% anticonvulsants and 33% lithium. When given in combination, lithium is the most often prescribed substance for bipolar depression (33%), followed by valproic acid (23%), mirtazapine and venlafaxine (16% each), quetiapine (15%), lamotrigine (14%) and olanzapine (13%). Both, lithium and valproic acid are often combined with selective serotonin reuptake inhibitors (SSRI), but also with mirtazapine und venlafaxine. Combinations of more than one antidepressant occur quite often, whereby combinations with bupropion, paroxetine, fluoxetine or fluvoxamine are very rare. In 2010, quetiapine (alone and combined) was the most frequently prescribed drug (39%); aripiprazole was administered in 10%.Combinations of antidepressants (SSRI, mirtazapine, venlafaxine) with mood stabilizers (lithium, valproic acid, lamotrigine) and / or atypical antipsychotics (quetiapine, olanzapine) are common. Of most of those combinations the efficacy has not been studied. The use of aripiprazole and the concomitant use of two or three antidepressants contrast the guidelines.For the treatment of bipolar depression a variety of partly controversial options exist. Several up to date guidelines provide clinicians with a framework of evidence based pharmacological treatments of bipolar depression [1-6].The present study shows the prescriptions of psychopharmacological substances for bipolar depression in daily clinical routine. The data from a large European multicenter study (AMSP) [7,8] allow a direct comparison between clinical routine and recommendations of the guideli

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