Complex psychotropic polypharmacy among patients with bipolar disorder
Navodya C. Selvaratnam
Abstract
Psychotropic polypharmacy, which is the use of two or more psychotropic drugs in the same patient could be simple or complex depending on the number of psychotropic drugs prescribed. In clinical psychiatry, a common practice of polypharmacy is observed. As polypharmacy can lead to adverse health outcomes in patients, it is a public health concern of greater significance. The contributing factors to polypharmacy may be patient-related or clinician-related. In comparison to other conditions, bipolar disorder is observed to be associated with complex polypharmacy more commonly. Despite the observations, research exploring the prescription patterns in treating patients with bipolar disorder and the practice of polypharmacy is limited. The present perspective illuminates the significance of prioritizing investigative explorations into prescription patterns and polypharmacy, focusing on bipolar disorder, and proposes an uncomplicated conceptual study design that can be utilized to conduct investigative explorations in the local context.
Keywords: Psychotropic polypharmacy, prescription patterns, bipolar disorder
References
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Adachi, N., Azekawa, T., Edagawa, K., Goto, E., Hongo, S., Kato, M., Katsumoto, E., Kikuchi, T., Kubota, Y., Miki, K., Nakagawa, A., Tsuboi, T., Ueda, H., Watanabe, K., Watanabe, Y., Yasui-Furukori, N., & Yoshimura, R. (2021). Estimated model of psychotropic polypharmacy for bipolar disorder: Analysis using patients' and practitioners' parameters in the MUSUBI study. Human Psychopharmacology: Clinical and Experimental, 36(2), e2764. https://doi.org/https://doi.org/10.1002/hup.2764
Aggarwal, R., & Ranganathan, P. (2019). Study designs: Part 2 - Descriptive studies. Perspect Clin Res, 10(1), 34-36. https://doi.org/10.4103/picr.PICR_154_18
Alharbi, F. F., Alharbi, S. F., Salih, S. B., & Al-Surimi, K. (2019). Correlates of Psychotropic Polypharmacy in outpatient psychiatric clinics of two military tertiary hospitals in Saudi Arabia. Journal of Family and Community Medicine, 26(3), 213-220. https://doi.org/10.4103/jfcm.JFCM_31_19
American Psychiatric Association. (2022). Bipolar and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787.x03_Bipolar_and_Related_Disorders
Amerio, A., Russo, D., Miletto, N., Aguglia, A., Costanza, A., Benatti, B., Odone, A., Barroilhet, S. A., Brakoulias, V., Dell'Osso, B., Serafini, G., Amore, M., & Ghaemi, S. N. (2021). Polypharmacy as maintenance treatment in bipolar illness: A systematic review. Acta Psychiatr Scand, 144(3), 259-276. https://doi.org/10.1111/acps.13312
Caraci, F., Enna, S. J., Zohar, J., Racagni, G., Zalsman, G., van den Brink, W., Kasper, S., Koob, G. F., Pariante, C. M., Piazza, P. V., Yamada, K., Spedding, M., & Drago, F. (2017). A new nomenclature for classifying psychotropic drugs. British Journal of Clinical Pharmacology, 83(8), 1614-1616. https://doi.org/https://doi.org/10.1111/bcp.13302
Fung, V. C., Overhage, L. N., Sylvia, L. G., Reilly-Harrington, N. A., Kamali, M., Gao, K., Shelton, R. C., Ketter, T. A., Bobo, W. V., Thase, M. E., Calabrese, J. R., Tohen, M., Deckersbach, T., & Nierenberg, A. A. (2019). Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors. Journal of Affective Disorders, 257, 17-22. https://doi.org/https://doi.org/10.1016/j.jad.2019.06.050
Golden, J. C., Goethe, J. W., & Woolley, S. B. (2017). Complex psychotropic polypharmacy in bipolar disorder across varying mood polarities: A prospective cohort study of 2712 inpatients. Journal of Affective Disorders, 221, 6-10. https://doi.org/https://doi.org/10.1016/j.jad.2017.06.005
Govaerts, J., Boeyckens, J., Lammens, A., Gilis, A., Bouckaert, F., De Hert, M., De Lepeleire, J., Stubbs, B., & Desplenter, F. (2021). Defining polypharmacy: in search of a more comprehensive determination method applied in a tertiary psychiatric hospital. Therapeutic Advances in Psychopharmacology, 11, 20451253211000610. https://doi.org/10.1177/20451253211000610
Grover, S., Avasthi, A., Chakravarty, R., Dan, A., Chakraborty, K., Neogi, R., Desouza, A., Nayak, O., Praharaj, S. K., Menon, V., Deep, R., Bathla, M., Subramanyam, A. A., Nebhinani, N., Ghosh, P., Lakdawala, B., Bhattacharya, R., & Gania, A. (2021). Prescription patterns in clinically stable patients with bipolar disorder: Findings from the Bipolar Disorder Course and Outcome from India (BiD-CoIN) study. Asian Journal of Psychiatry, 57, 102549. https://doi.org/https://doi.org/10.1016/j.ajp.2021.102549
Hu, J., McMillan, S. S., Theodoros, T., Collins, J. C., El-Den, S., O’Reilly, C. L., & Wheeler, A. J. (2022). Psychotropic medication use in people living with severe and persistent mental illness in the Australian community: a cross-sectional study. BMC Psychiatry, 22(1), 705. https://doi.org/10.1186/s12888-022-04324-0
Kim, A. M., Salstein, L., & Goldberg, J. F. (2021). A Systematic Review of Complex Polypharmacy in Bipolar Disorder: Prevalence, Clinical Features, Adherence, and Preliminary Recommendations for Practitioners. J Clin Psychiatry, 82(3). https://doi.org/10.4088/JCP.20r13263
Lin, S. K., Yang, S. Y., Park, S. C., Jang, O. J., Zhu, X., Xiang, Y. T., Ouyang, W. C., Javed, A., Khan, M. N. S., Grover, S., Avasthi, A., Kallivayalil, R. A., Chee, K. Y., Chemi, N., Kato, T. A., Hayakawa, K., Pariwatcharakul, P., Maramis, M., Seneviratne, L., . . . Shinfuku, N. (2022). Prescription Patterns for Bipolar Disorder in Asian Countries: Findings from Research on Asian
Prescription Pattern-Bipolar Disorder. Clin Psychopharmacol Neurosci, 20(1), 61-69. https://doi.org/10.9758/cpn.2022.20.1.61
National Institute of Mental Health. (2023). Bipolar disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder
Reiser, R. (2015). Bipolar Disorder. In S. K. Whitbourne (Ed.), The Encyclopedia of Adulthood and Aging (pp. 1-5). https://doi.org/https://doi.org/10.1002/9781118521373.wbeaa136
Rothschild, A. J. (2021). The Pitfalls of Psychotropic Polypharmacy. Journal of Clinical Psychopharmacology, 41(3), 227-232. https://doi.org/10.1097/jcp.0000000000001400
Seifert, J., Maier, H. B., Führmann, F., Bleich, S., Stübner, S., Sieberer, M., Bernegger, X., Greil, W., Schüle, C., Toto, S., Grohmann, R., & Reinhard, M. A. (2022). Pharmacological treatment of major depressive disorder according to severity in psychiatric inpatients: results from the AMSP pharmacovigilance program from 2001–2017. Journal of Neural Transmission, 129(7), 925-944. https://doi.org/10.1007/s00702-022-02504-6
Setia, M. S. (2016). Methodology Series Module 3: Cross-sectional Studies. Indian J Dermatol, 61(3), 261-264. https://doi.org/10.4103/0019-5154.182410
Wang, X., & Cheng, Z. (2020). Cross-Sectional Studies: Strengths, Weaknesses, and Recommendations. Chest, 158(1s), S65-s71. https://doi.org/10.1016/j.chest.2020.03.012
Wang, Z., Li, T., Li, S., Li, K., Jiang, X., Wei, C., Yang, L., Cao, H., Li, S., & Li, J. (2022). The prevalence and clinical correlates of medical disorders comorbidities in patients with bipolar disorder. BMC Psychiatry, 22(1), 176. https://doi.org/10.1186/s12888-022-03819-0
WHO Collaborating Centre for Drug Statistics Methodology. (2023). ATC/DDD Index 2024. https://www.whocc.no/atc_ddd_index/
World Health Organization. (2023). Bipolar or related disorders. In International classification of diseases (11th ed.). https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f613065957
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., Alda, M., MacQueen, G., Milev, R. V., Ravindran, A., O'Donovan, C., McIntosh, D., Lam, R. W., Vazquez, G., Kapczinski, F., . . . Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97-170. https://doi.org/https://doi.org/10.1111/bdi.12609
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Reviewer A comments:
Authors' reply: Will be uploaded soon