Real-World Prescribing Patterns for Patients With Newly Diagnosed Bipolar Disorder

Psych Congress Steering Committee Member Rakesh Jain, MD, MPH, and co-authors Mousam Parikh, AbbVie, and Huy-Binh Nguyen, PhD, AbbVie, answer questions about their study that found a disconnect between treatment guidelines and the prescribing practices of clinicians treating bipolar disorder.

In Part 1 of this Q&A, they discuss the impetus for the study, the most significant findings, and advice for clinicians treating bipolar disorder who are looking to align with current treatment guidelines.

The study, “Treatment Patterns Among Patients with Bipolar Disorder in the United States: A Retrospective Claims Database Analysis,” was published online in Advances in Therapy.

Read Part 2, where the study authors explore practical implications of the study findings, surprising outcomes, and areas of future research, here!

Question: What led you and your colleagues to look into treatment patterns among patients with bipolar disorder (BD) in the US?

Answer: Working with the AbbVie team, we undertook this study to better understand how real-world prescribing for patients with newly diagnosed bipolar disorder compared with the recommended clinical treatment guidelines, and to characterize which medications were being prescribed.

Question: Please briefly describe the study method and your most significant finding(s).

Answer: We conducted a retrospective, observational study using medical and pharmacy claims data from the IBM® Marketscan® Commercial database. Patients with a new diagnosis of bipolar disorder were identified and followed-up with for at least 6 months after diagnosis to characterize treatment patterns across multiple bipolar episodes. We found that antidepressants, mood stabilizers, and atypical antipsychotics were the most common medications used to treat patients with bipolar disorder. Antidepressants and benzodiazepines were frequently prescribed to treat bipolar I depression, even though these medications are not recommended in treatment guidelines. During their first-line of therapy for either a manic or depressive episode, only 12% of patients with BP-I depression and 22% of patients with BP-I mania received guideline-recommended treatment, suggesting that there is a disconnect between prescribing practices and treatment guidelines.

Question: The results of the study were consistent with previous literature that found BD is often treated “inappropriately.” Why does this happen and what advice do you have for clinicians treating BD who are seeking appropriate treatment for their patients?

Answer: Guideline-incongruent treatment for bipolar disorder is a multifaceted problem that begins with misdiagnosis for many patients. Secondly, clinicians may rely on prior experience, or focus on treating the presenting symptom rather than considering the underlying disorder. Additionally, patients with bipolar I disorder often have comorbidities (e.g., anxiety) for which clinicians may be prescribing treatments, such as benzodiazepines. We recommend that clinicians do a careful clinical evaluation to uncover a past manic or hypomanic episode. Once a correct diagnosis is established, clinicians can consult bipolar disorder treatment guidelines, which provide recommendations for evidence-based treatments that are appropriate for manic and depressive episodes.

Rakesh Jain, MD, MPH, attended medical school at the University of Calcutta in India. He then attended graduate school at the University of Texas School of Public Health in Houston, where he was awarded a “National Institute/Center for Disease Control Competitive Traineeship”. His research thesis focused on impact of substance abuse. He graduated from the School of Public Health in 1987 with a Masters of Public Health (MPH) degree.

Dr. Jain served a three-year residency in Psychiatry at the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston. He followed that by obtaining further specialty training, by undergoing a two-year fellowship in Child and Adolescent Psychiatry. In addition, Dr. Jain completed a postdoctoral fellowship in Research Psychiatry at the University of Texas Mental Sciences Institute, in Houston. He was awarded the “National Research Service Award” for the support of this postdoctoral fellowship.

Mousam Parikh is the lead for AbbVie Psychiatry’s Health Economics and Outcomes Research (HEOR) team. She completed her Bachelors in Pharmacy from Mumbai, India and a Masters focusing on HEOR from Duquesne University, PA. She is focused on generating high-quality evidence by leveraging real-world data to understand unmet needs, treatment patterns and outcomes associated with treatments in the mental health space.

Huy-Binh Nguyen is a Scientific Director at AbbVie leading the Schizophrenia and Bipolar-1 Disorder therapeutic areas within psychiatry US medical affairs. Dr. Nguyen received both his bachelors (physiology) and PhD (neuroscience) degrees from McGill University in Montreal, Quebec, Canada. Among his professional interests are how rates of bipolar-1 depression misdiagnosis may be reduced by improved screening of patients presenting for care with depressive symptoms.