Use of polypharmacy and self-reported mood in outpatients with bipolar disorder.

Objective. As polypharmacy is routinely used for the treatment of bipolar disorder, the relation between the daily number of psychotropic medications and self-reported mood was investigated. Method. Eighty patients (35 men and 45 women) with a diagnosis of bipolar disorder I or II, recruited from academic centres, entered their mood, sleep, and psychotropic medications for 3 months into ChronoRecord software. A total of 8662 days of data was received (mean 114.7 days/per patient). Results. Seventy-nine patients took a mean of 3.8 medications daily (SD 1.7; range 1-9); one took none. Of these patients, 73 (92.4%) took mood stabilizers, 47 (58.8%) took antidepressants, 31 (38.8%) took antipsychotics, 34 (42.5%) took benzodiazepines and 17 (21.1%) took thyroid hormones. Patients reporting normal mood more frequently took fewer medications; the Pearson correlation coefficient between the number of medications and the percent of days normal was -0.481 (P < 0.001). Grouping by number of medications, ANOVA analysis showed those taking fewer medications reported normal mood more frequently (P<0.001). Conclusion. Combination treatment regimens are routinely prescribed for bipolar disorder. Patients reporting normal mood more frequently took a fewer number of daily medications. Studies are needed to better identify those patients who would benefit from polypharmacy and to optimise the combinations of medications for patients with refractory disorder.