Prescription sequences in bipolar disorder - A nationwide Danish register-based study of 19,927 individuals followed for 10 years.
| Title: | Prescription sequences in bipolar disorder - A nationwide Danish register-based study of 19,927 individuals followed for 10 years. |
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| Authors: | Jorgensen A; Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark. Electronic address: anders.01.joergensen@regionh.dk.; Sloth MMB; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark.; Larsen EN; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark.; Osler M; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen K, Denmark.; Kessing LV; Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark. |
| Source: | European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology [Eur Neuropsychopharmacol] 2025 Apr; Vol. 93, pp. 51-57. Date of Electronic Publication: 2025 Feb 16. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 9111390 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-7862 (Electronic) Linking ISSN: 0924977X NLM ISO Abbreviation: Eur Neuropsychopharmacol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Amsterdam : Elsevier, c1990- |
| MeSH Terms: | Bipolar Disorder*/drug therapy ; Bipolar Disorder*/epidemiology ; Bipolar Disorder*/diagnosis ; Antidepressive Agents*/therapeutic use ; Anticonvulsants*/therapeutic use ; Antipsychotic Agents*/therapeutic use ; Drug Prescriptions*/statistics & numerical data ; Antimanic Agents*/therapeutic use ; Registries*; Denmark/epidemiology ; Humans ; Male ; Female ; Adult ; Middle Aged ; Follow-Up Studies ; Young Adult ; Aged ; Cohort Studies |
| Abstract: | Evidence-based use of pharmacological interventions in bipolar disorder is of paramount clinical importance. We aimed to uncover precription sequences in a large cohort of patients from the first diagnosis of bipolar disorder. Using Danish nationwide registers, we identified individuals with a first-time hospital diagnosis of bipolar disorder between January 1st, 2001, and December 31st, 2016. Redemeed prescriptions of litihum, anticonvulsants, antipsychotics, and antidepressants from five years before to five years after diagnosis were retreived. The data were analysed with descriptive statistics, sunburst plots, and Cox proportioal hazard models. The full study population consisted of 19,927 individuals. Before diagnosis, antidepressants were the predominantly prescribed group (46.9 % as first drug). After diagnosis, a major trend towards mood stabilising strategies was observed. although only 18.7 % received lithiumas first prescription. In analyses stratified for illness phase, lithium was more frequently prescribed as first drug after depression than after hypomania/mania, in which antidepressants were used as first drug in 10-15 % of the cases. Treatment sequences were highly heterogeneous (2,459 distinct sequences for the 19,927 individuals under investigation). Lithium appeared to carry the overall highest risk of treatment shift. We conclude that in accordance with national and international guidelines, a diagnosis of bipolar disorder leads to a relevant change of treatment strategy towards mood stabilising drugs. However, lithium continues to be underused;antidepressants probably used too frequently, and treatment sequences are highly heterogeneous and not adjusted according to illness phase. These results point to a potential for optimising the real-world pharmacological management of bipolar disorder.; (Copyright © 2025. Published by Elsevier B.V.) |
| Competing Interests: | Declaration of competing interest LVK has during the recent three years been a consultant for Teva and Lundbeck without relation to the current manuscript. None of the other authors have any conflicts of interest to declare. |
| Contributed Indexing: | Keywords: Anticonvulsants; Antidepressants; Antipsychotics; Bipolar disorder; Lithium; Prescriptionsequences |
| Substance Nomenclature: | 0 (Antidepressive Agents); 0 (Anticonvulsants); 0 (Antipsychotic Agents); 0 (Antimanic Agents) |
| Entry Date(s): | Date Created: 20250216 Date Completed: 20250508 Latest Revision: 20250508 |
| Update Code: | 20260130 |
| DOI: | 10.1016/j.euroneuro.2025.01.008 |
| PMID: | 39955809 |
| Database: | MEDLINE |
Journal Article