Greil Waldemar, de Bardeci Mateo, Nievergelt Nadja, Erfurth Andreas, Hasler Gregor, Bridler Rene, Toto Sermin, Grohmann Renate, Seifert Johanna, Schoretsanitis Georgios
Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Zurich, Germany.
Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland.
Int J Bipolar Disord. 2025 Feb 13;13(1):3. doi: 10.1186/s40345-025-00370-1.
Global pharmacoepidemiological evidence suggests dynamically changing prescription patterns in patients with bipolar disorders. We assessed trends in the use of pharmacological agents used in the management of bipolar disorders in inpatients.
We examined drug use data provided by the Drug Safety in Psychiatry Programme AMSP (German: "Arzneimittelsicherheit in der Psychiatrie"), including psychiatric hospitals in Germany, Austria and Switzerland. We included data from adult inpatients with bipolar disorders (ICD-10: F31) treated between 1994 and 2017. We compared prescription patterns between patients receiving therapeutic regimens with vs. without lithium. Patients with manic and depressive episodes were also analyzed separately.
We identified a total of 8,707 patients (58% females, mean age 50.8 ± 14.8 years). Our analysis revealed a decrease of lithium use (up to 2004) and a consistent increase of prescription rates for second-generation antipsychotics (SGA) among which quetiapine (n = 2,677) and olanzapine (n = 1,536) were the most common. Among psychotropic drugs, quetiapine was most frequently combined with lithium (n = 716, 25.6%). Lithium-treated patients received a higher number of drugs compared to patients not receiving lithium (mean number of drugs in patients with vs. without lithium 4.99, n = 2,796 vs. 4.75, n = 5,911, p = 0.002). Thyroid therapeutics were given more often, valproate and quetiapine less often in the lithium group. Antidepressants were consistently prescribed to more than 60% of patients with bipolar depressive episodes.
Our findings suggest that SGAs are gradually becoming the mainstay treatment option in bipolar disorder, continuously replacing lithium. The use of antidepressants remains concerningly high. We call for action to improve adherence to evidence-based guidelines.
全球药物流行病学证据表明，双相情感障碍患者的处方模式在动态变化。我们评估了住院双相情感障碍患者使用的药物治疗趋势。
我们研究了由精神科药物安全计划AMSP（德语：“Arzneimittelsicherheit in der Psychiatrie”）提供的药物使用数据，该计划涵盖德国、奥地利和瑞士的精神病医院。我们纳入了1994年至2017年间接受治疗的成年双相情感障碍住院患者（ICD-10：F31）的数据。我们比较了接受含锂与不含锂治疗方案的患者之间的处方模式。还分别分析了躁狂发作和抑郁发作的患者。
我们共确定了8707名患者（58%为女性，平均年龄50.8±14.8岁）。我们的分析显示锂的使用量减少（直至2004年），第二代抗精神病药物（SGA）的处方率持续上升，其中喹硫平（n = 2677）和奥氮平（n = 1536）最为常见。在精神药物中，喹硫平最常与锂联合使用（n = 716，25.6%）。与未接受锂治疗的患者相比，接受锂治疗的患者使用的药物数量更多（接受锂治疗与未接受锂治疗的患者平均药物数量分别为4.99，n = 2796 vs. 4.75，n = 5911，p = 0.002）。锂治疗组甲状腺治疗药物的使用更频繁，丙戊酸盐和喹硫平的使用较少。超过60%的双相抑郁发作患者持续使用抗抑郁药。
我们的研究结果表明，第二代抗精神病药物正逐渐成为双相情感障碍的主要治疗选择，不断取代锂。抗抑郁药的使用仍然高得令人担忧。我们呼吁采取行动，提高对循证指南的依从性。
