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. 2011;6(12):e28725.
doi: 10.1371/journal.pone.0028725. Epub 2011 Dec 7.

Prescribing trends in bipolar disorder: cohort study in the United Kingdom THIN primary care database 1995-2009

Joseph Hayes  1 , Philip Prah, Irwin Nazareth, Michael King, Kate Walters, Irene Petersen, David Osborn
Affiliations

Prescribing trends in bipolar disorder: cohort study in the United Kingdom THIN primary care database 1995-2009

Joseph Hayes et al. PLoS One. 2011.

Abstract

Objectives: To determine changes in prescribing patterns in primary care of antipsychotic and mood stabiliser medication in a representative sample of patients with bipolar disorder in the United Kingdom over a fifteen year period and association with socio-demographic factors.

Methods: We identified 4700 patients in the Health Improvement Network (THIN) primary care database, who had received treatment for bipolar disorder between 1995 and 2009. The proportion of time for which each individual was prescribed a particular medication was studied, along with variation by sex, age and social depravation status (quintiles of Townsend scores). The number of drugs an individual was taking within a particular year was also examined.

Results: In 1995, 40.6% of patients with bipolar disorder were prescribed a psychotropic medication at least twice. By 2009 this had increased to 78.5% of patients. Valproate registered with the greatest increase in use (22.7%) followed by olanzapine (15.7%) and quetiapine (9.9%). There were differences by age and sex; with young (18-30 year old) women having the biggest increase in proportion of time on medication. There were no differences by social deprivation status. By 2009, 34.2% of women of childbearing age were treated with valproate.

Conclusions: Lithium use overall remained relatively constant, whilst second generation antipsychotic and valproate use increased dramatically. Changes in prescribing practice preceded published trial evidence, especially with the use of second generation antipsychotics, perhaps with inferences being made from treatment of schizophrenia and use of first generation antipsychotics. Women of childbearing age were prescribed valproate frequently, against best advice.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Proportion of time in treatment with antipsychotic medication.
Figure 2
Figure 2. Proportion of time in treatment with mood stabiliser medication.
Figure 3
Figure 3. Prescribing of the 5 most common antipsychotic medications by sex.
A) Male, B) Female.
Figure 4
Figure 4. Prescribing of mood stabilisers by sex.
A) Male and B) Female.
Figure 5
Figure 5. Prescribing by age group.
A) First generation antipsychotic, B) Second generation antipsychotic, C) Lithium, D) Anticonvulsant.
Figure 6
Figure 6. Percentage of treated individuals by medication group in A) 1995 and B) 2009*.
*Not to scale - 1995 euler diagram should be approximately 1/80th the size of 2009.
See this image and copyright information in PMC

References

    1. Goodwin GM. Evidence-based guidelines for treating bipolar disorder: revised second edition - recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology. 2009;23(4):346–388. - PubMed
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington (DC): American Psychiatric Association; 1994.
    1. Baldessarini RJ. Treatment research in bipolar disorder: issues and recommendations. CNS Drugs. 2002;2002;16:721–729. - PubMed
    1. NICE. Bipolar disorder The management of Bipolar disorder in Adults, children and adolescents in Secondary and Primary care. Nice Guideline. 2006;38 - PubMed
    1. Maudsley Prescribing Guidelines. 10th Edition. England: Informa Healthcare; 2009.

MeSH terms