Koistinaho Aura, Poranen Juulia, Tanskanen Antti, Tiihonen Jari, Taipale Heidi, Lähteenvuo Markku
Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
J Affect Disord. 2023 Nov 1;340:237-244. doi: 10.1016/j.jad.2023.08.015. Epub 2023 Aug 8.
Pharmacotherapy remains crucial for treating bipolar disorder (BD), but knowledge on the treatments actually used by newly diagnosed patients in real-world settings is sparse.
Individuals newly diagnosed with BD during 1996-2018, aged 15-65 years, were identified from national Finnish registers. The patients' use of different drug classes (mood stabilizers, antipsychotics and antidepressants) or combinations of these drug classes were followed from initial pharmacotherapy (first line) after BD diagnosis until the fifth line of treatment or until the two-year follow-up time ended. Clinical and sociodemographic factors associated with antidepressants-only as the first treatment line were assessed with logistic regression.
82.6 % of all patients used BD medication during the follow-up. 33.9 % had antidepressants-only as the first, 22.9 % as the second and 19.7 % as the third treatment line. Use of combinations of mood stabilizers, antipsychotics and antidepressants increased by successive treatment lines. Factors associated with antidepressants-only as the first treatment line included older age (>45 years aOR 2.20, 95% CI: 2.01-2.40, 25-45 years: 1.55, 1.42-1.68, compared with those aged <25), diabetes (1.35, 1.17-1.55) and female sex (1.29, 1.21-1.37). BD diagnosis registered in 2016-2018 (0.48, 0.42-0.55) and substance abuse (0.77, 0.71-0.83) were associated with decreased odds.
Due to the register-based nature of this study, not all potentially important clinical factors influencing medication use could be controlled for.
A large proportion of patients with bipolar disorder are not treated according to treatment guidelines, as use of antidepressants alone is common. Reasons for not following evidence-based recommendations need to be further researched.
药物治疗对于双相情感障碍（BD）的治疗仍然至关重要，但对于新诊断患者在现实环境中实际使用的治疗方法的了解却很少。
从芬兰国家登记册中识别出1996年至2018年期间新诊断为BD的15至65岁个体。从BD诊断后的初始药物治疗（一线治疗）开始，跟踪患者使用不同药物类别（心境稳定剂、抗精神病药物和抗抑郁药物）或这些药物类别的组合情况，直至第五线治疗或直至两年随访期结束。使用逻辑回归评估与仅将抗抑郁药物作为一线治疗相关的临床和社会人口学因素。
在随访期间，82.6%的患者使用了BD药物。33.9%的患者仅将抗抑郁药物作为一线治疗，22.9%作为二线治疗，19.7%作为三线治疗。随着治疗线数的增加，心境稳定剂、抗精神病药物和抗抑郁药物组合的使用也增加。与仅将抗抑郁药物作为一线治疗相关的因素包括年龄较大（>45岁，调整后比值比[aOR]为2.20，95%置信区间[CI]：2.01 - 2.40；25 - 45岁：1.55，1.42 - 1.68，与<25岁者相比）、糖尿病（1.35，1.17 - 1.55）和女性（1.29，1.21 - 1.37）。2016 - 2018年登记的BD诊断（0.48，0.42 - 0.55）和药物滥用（0.77，0.71 - 0.83）与较低的比值相关。
由于本研究基于登记册的性质，并非所有影响药物使用的潜在重要临床因素都能得到控制。
很大一部分双相情感障碍患者未按照治疗指南进行治疗，因为单独使用抗抑郁药物很常见。不遵循循证推荐的原因需要进一步研究。
