Almost one-third of patients with bipolar I disorder were taking at least four psychotropic medications when admitted to a psychiatric hospital, researchers reported in the April issue of Psychiatry Research.
The findings "reflect the enormous challenge of symptom management" in bipolar I disorder and the "fine line between help and harm that clinicians face" because monotherapies for [bipolar disorder] often are ineffective, said Dr. Lauren M. Weinstock and her associates at Brown University and Butler Hospital in Providence, R.I.
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Almost one-third of patients with bipolar I disorder were taking at least four psychotropic medications when admitted to a psychiatric hospital, researchers reported in the April issue of Psychiatry Research.
Using a computer algorithm, the investigators reviewed the charts of 218 adults with bipolar I disorder presenting for admission to a single psychiatric hospital. Patients averaged 42 years in age (range, 18-77), and 58% were female (Psychiatry Res. 2014;216:24-30).
In all, 82 patients (32%) were taking at least four psychotropic medications on admission. Taking this many medications was significantly associated with comorbid anxiety disorder (P less than .001), depression on admission (P = .002), a past suicide attempt (P = .010), and female gender (P = .025). Women were more likely than men to be prescribed benzodiazepines (P = .008), antidepressants (P = .012), and stimulants (P = .052), even after depressed mood was controlled for.
The results highlight concerns about an "increased risk of adverse side effects, drug interactions, medication error, and poor treatment adherence," and the complex polypharmacy’s "high cost burden to both patients and the health care system," said Dr. Weinstock and her associates. They emphasized the need for more research on outpatient prescribing for bipolar disorder patients and "the potential risks, especially for women, of iatrogenic complications without evidence of potential benefits."
The researchers did not use supplementary methods to confirm chart data and could not distinguish between long-standing treatment patterns or recent changes to medications. Because 94% of patients were white and most had health insurance, the findings could not be generalized to other patient populations.
A grant from the National Institute of Mental Health funded manuscript preparation. The authors did not disclose conflicts of interest.