Shafiq Samreen, Ronksley Paul Everett, Elliott Meghan Jessica, Bulloch Andrew Gabriel McKay, Patten Scott Burton
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
Can J Psychiatry. 2025 Jul 10:7067437251355643. doi: 10.1177/07067437251355643.
AimsThe approval of new drugs for bipolar disorder (BD) may have caused a shift in prescribing trends among patients with BD. The objective of the study was to describe prescribing trends amongst individuals with BD in Alberta, Canada.MethodsThis study used provincial administrative health data from Alberta, Canada. Individuals with at least one ICD-9 or ICD-10 code for BD were identified from three databases - Provider claims, Hospital Discharge Abstract Database and the Ambulatory Care Classification System. Within this cohort, we identified prevalent, new and combination use of commonly prescribed BD drugs through prescription information from the Pharmaceutical Information Network database.ResultsBetween April 1, 1994, and March 31, 2021, 136,628 individuals had at least 1 code of BD with 9,466,407 prescriptions dispensed between January 1, 2008 to March 31, 2021. New users of all drugs declined over time, especially from 2019 to 2021. Among all BD drugs, antidepressants were the most commonly prescribed in both prevalent and new users throughout the study period. Among recommended treatments for BD, quetiapine was one of the most prescribed drugs amongst prevalent users. An overall decline was noted in prescribing of lithium, divalproex and carbamazepine among prevalent and new users. Most individuals were prescribed a single drug for BD treatment. The most common combination therapy for prevalent users was an antidepressant with a second-generation antipsychotic (SGA).ConclusionsOverall, we uncovered a concerning trend in the prescribing patterns for BD treatment, with antidepressants and SGAs being prescribed frequently and a decline in prescribing of lithium and other mood stabilizers. This study emphasizes the need for initiatives promoting evidence-based guidelines and better alignment with best practices for managing BD in outpatient settings.
目的
双相情感障碍（BD）新药的获批可能导致了BD患者处方趋势的转变。本研究的目的是描述加拿大艾伯塔省BD患者的处方趋势。
方法
本研究使用了来自加拿大艾伯塔省的省级行政卫生数据。从三个数据库——医疗服务提供者索赔数据库、医院出院摘要数据库和门诊护理分类系统中识别出至少有一个BD的ICD-9或ICD-10编码的个体。在这个队列中，我们通过药物信息网络数据库中的处方信息确定了常用BD药物的流行使用、新使用和联合使用情况。
结果
在1994年4月1日至2021年3月31日期间，136,628人至少有一个BD编码，在2008年1月1日至2021年3月31日期间共发放了9,466,407张处方。所有药物的新使用者随时间减少，尤其是从2019年到2021年。在整个研究期间，在流行使用者和新使用者中，抗抑郁药都是最常处方的药物。在BD的推荐治疗药物中，喹硫平是流行使用者中处方最多的药物之一。在流行使用者和新使用者中，锂盐、丙戊酸和卡马西平的处方量总体呈下降趋势。大多数个体接受单一药物治疗BD。流行使用者最常见的联合治疗是抗抑郁药与第二代抗精神病药（SGA）联合使用。
结论
总体而言，我们发现BD治疗的处方模式存在令人担忧的趋势，抗抑郁药和SGA的处方频繁，而锂盐和其他心境稳定剂的处方量下降。本研究强调需要采取举措推广循证指南，并更好地与门诊环境中管理BD的最佳实践保持一致。
