Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, TX, USA.
J Affect Disord. 2013 Sep 5;150(2):424-9. doi: 10.1016/j.jad.2013.04.034. Epub 2013 Jun 6.
To examine the psychotropic medication utilization and compare adherence to treatment regimens in pediatric bipolar depression patients.
2003-2007 MAX data from four geographically diverse states were used. According to the regimen received by the patients (6-18 years) in the first month after the index bipolar depression diagnosis, patients were categorized into six mutually exclusive groups. The month to month change of treatment regimen in each group was then assessed during the 6 month post-index bipolar depression diagnosis. Adherence to each regimen was measured as continuation of the initial regimen, switch to a new regimen, augmentation with medication from a different therapeutic category, and discontinuation of all pharmacotherapies. Repeated measure analysis was conducted to compare the trend of each adherence measure across the study groups.
Of the 5,460 subjects identified, 15.39% received antipsychotic monotherapy, 9.43% received mood stabilizer monotherapy, 5.77% received antidepressant monotherapy, 26.48% received mood stabilizer-antipsychotic polytherapy, 22.51% received antidepressant polytherapy, and 19.89% received antipsychotic-mood stabilizer-antidepressant polytherapy. At the end of the follow-up period, over 50% of the 1st month polytherapy users and less than 50% of the monotherapy users were continuing their initial regimen. Repeated measure analysis using antipsychotic monotherapy as the reference group suggested differences in trend slopes (p<0.05).
In absence of structured clinical evaluation, bipolar disorder diagnoses cannot be ascertained in this study.
Bipolar depression patients were predominantly treated with combinations of psychotropic drugs. Potentially questionable practice, such as antidepressant monotherapy was used only in a small fraction of patients. Combination regimens had better adherence as compared to monotherapies.
研究目的是检查儿童双相抑郁患者的精神药物使用情况并比较治疗方案的依从性。
本研究使用了来自四个地理位置不同的州的 2003-2007 年 MAX 数据。根据患者（6-18 岁）在指数双相抑郁诊断后的第一个月接受的治疗方案，将患者分为六个互斥的组别。然后在指数双相抑郁诊断后 6 个月内评估每个组别治疗方案的逐月变化。通过以下方法衡量每种治疗方案的依从性：继续初始方案、更换新方案、用不同治疗类别的药物进行增效治疗以及停止所有药物治疗。采用重复测量分析比较各研究组之间每种依从性测量指标的趋势。
在所确定的 5460 名患者中，15.39%接受了抗精神病药单药治疗，9.43%接受了心境稳定剂单药治疗，5.77%接受了抗抑郁药单药治疗，26.48%接受了心境稳定剂-抗精神病药联合治疗，22.51%接受了抗抑郁药联合治疗，19.89%接受了抗精神病药-心境稳定剂-抗抑郁药联合治疗。在随访期末，超过 50%的第 1 个月联合治疗组患者在继续使用初始方案，而不到 50%的单药治疗组患者在继续使用初始方案。采用抗精神病药单药治疗作为参考组的重复测量分析表明，趋势斜率存在差异（p<0.05）。
由于缺乏结构化临床评估，因此无法在本研究中确定双相障碍诊断。
双相抑郁患者主要接受精神药物联合治疗。在一小部分患者中，仅使用了可能存在问题的治疗方法，如抗抑郁药单药治疗。与单药治疗相比，联合治疗方案的依从性更好。
