Study findings highlight the frequent use of complex polypharmacy in patients with bipolar disorder, with women especially likely to be taking multiple medications.
In a cohort of patients hospitalised for an acute mood episode, 36% were taking four or more psychotropic medications, report Lauren Weinstock (Alpert Medical School of Brown University and Butler Hospital, Providence, Rhode Island, USA) and colleagues.
Some of these cases may represent “ ‘rational’ or evidence based polypharmacy that may yield clinical benefit”, write the researchers in Psychiatry Research.
“Yet study data also highlight the ‘fine line between help and harm’ that clinicians face in light of the current limited effectiveness of monotherapy for [bipolar disorder] and the increased trend toward polypharmacy with both psychotropic and non-psychotropic medications.”
Most (81%) of the 230 patients in the study had been taking psychotropic medication before hospitalisation, with these patients taking an average of 3.31 psychotropic drugs and 5.94 total drugs. Complex polypharmacy was present in 44% of those taking any medication at hospital admission, and 36% of the whole cohort.
“This finding is especially striking, as patients presented as acutely symptomatic despite high rates of polypharmacy,” says the team.
Patients were significantly more likely to be taking complex polypharmacy if they were female, had a comorbid anxiety disorder and had previously attempted suicide. The associations remained significant after accounting for current depression, despite this being associated both with complex polypharmacy and the other predictive factors.
This suggests that the “presence of depression alone was not sufficient to explain increased rates of polypharmacy among these patient subgroups”, say Weinstock et al, adding that the finding is consistent with previous research.
Women were more likely than men to be taking antidepressants, benzodiazepines and stimulants, after accounting for type of current mood episode.
The researchers suggest that compared with men perhaps “women are more accepting of such medications or, consistent with greater rates of mental health treatment seeking in women more generally, have more frequent contact with medication providers and hence greater opportunity for pharmacotherapy augmentation.”
They add: “It may also be that women are perceived by providers as having greater need for augmentation with these agents.”
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