Jorgensen Anders, Sloth Mathilde Marie Brünnich, Larsen Emma Neble, Osler Merete, Kessing Lars Vedel
Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark.
Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark.
Eur Neuropsychopharmacol. 2025 Apr;93:51-57. doi: 10.1016/j.euroneuro.2025.01.008. Epub 2025 Feb 16.
Evidence-based use of pharmacological interventions in bipolar disorder is of paramount clinical importance. We aimed to uncover precription sequences in a large cohort of patients from the first diagnosis of bipolar disorder. Using Danish nationwide registers, we identified individuals with a first-time hospital diagnosis of bipolar disorder between January 1, 2001, and December 31, 2016. Redemeed prescriptions of litihum, anticonvulsants, antipsychotics, and antidepressants from five years before to five years after diagnosis were retreived. The data were analysed with descriptive statistics, sunburst plots, and Cox proportioal hazard models. The full study population consisted of 19,927 individuals. Before diagnosis, antidepressants were the predominantly prescribed group (46.9 % as first drug). After diagnosis, a major trend towards mood stabilising strategies was observed. although only 18.7 % received lithiumas first prescription. In analyses stratified for illness phase, lithium was more frequently prescribed as first drug after depression than after hypomania/mania, in which antidepressants were used as first drug in 10-15 % of the cases. Treatment sequences were highly heterogeneous (2,459 distinct sequences for the 19,927 individuals under investigation). Lithium appeared to carry the overall highest risk of treatment shift. We conclude that in accordance with national and international guidelines, a diagnosis of bipolar disorder leads to a relevant change of treatment strategy towards mood stabilising drugs. However, lithium continues to be underused;antidepressants probably used too frequently, and treatment sequences are highly heterogeneous and not adjusted according to illness phase. These results point to a potential for optimising the real-world pharmacological management of bipolar disorder.
在双相情感障碍中基于证据使用药物干预具有至关重要的临床意义。我们旨在揭示一大群双相情感障碍初诊患者的用药顺序。利用丹麦全国性登记数据，我们确定了2001年1月1日至2016年12月31日期间首次因双相情感障碍住院诊断的个体。获取了诊断前五年至诊断后五年的锂盐、抗惊厥药、抗精神病药和抗抑郁药的报销处方。数据采用描述性统计、旭日图和Cox比例风险模型进行分析。完整的研究人群包括19927名个体。诊断前，抗抑郁药是主要的处方药物组（46.9%作为首选用药）。诊断后，观察到向情绪稳定策略的主要趋势。尽管只有18.7%的患者首次处方使用锂盐。在按疾病阶段分层的分析中，锂盐在抑郁发作后比在轻躁狂/躁狂发作后更常作为首选用药，在轻躁狂/躁狂发作后的病例中，10 - 15%的患者首选用药为抗抑郁药。治疗顺序高度异质性（19927名受调查个体有2459种不同顺序）。锂盐似乎总体上治疗转换风险最高。我们得出结论，根据国家和国际指南，双相情感障碍的诊断会导致治疗策略向情绪稳定药物发生相关改变。然而，锂盐的使用仍然不足；抗抑郁药可能使用过于频繁，并且治疗顺序高度异质性且未根据疾病阶段进行调整。这些结果表明在双相情感障碍的实际药物治疗管理方面有优化的潜力。
