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Open Access Highly Accessed Research article

Mono- and combination drug therapies in hospitalized patients with bipolar depression. Data from the European drug surveillance program AMSP

Anne Haeberle1, Waldemar Greil12*, Stefan Russmann3 and Renate Grohmann1

Author affiliations

1 Department of Psychiatry, Ludwig Maximilian University, Munich, Germany, Nussbaumstr. 7, Munich, 80336, Germany

2 Sanatorium Kilchberg, Alte Landstrasse 70, Kilchberg-Zurich, 8802, Switzerland

3 Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland

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Citation and License

BMC Psychiatry 2012, 12:153  doi:10.1186/1471-244X-12-153

Published: 21 September 2012

Abstract

Background

For the pharmacological treatment of bipolar depression several guidelines exist. It is largely unknown, to what extent the prescriptions in daily clinical routine correspond to these evidence based recommendations and which combinations of psychotropic drugs are frequently used.

Methods

The prescriptions of psychotropic drugs were investigated of all in-patients with bipolar depression (nā€‰=ā€‰2246; time period 1994ā€“2009) from hospitals participating in the drug surveillance program AMSP. For the drug use in 2010, 221 cases were analysed additionally.

Results

From 1994 to 2009, 85% of all patients received more than one class of psychotropic substances: 74% received antidepressants in combination therapy, 55% antipsychotics, 48% anticonvulsants and 33% lithium. When given in combination, lithium is the most often prescribed substance for bipolar depression (33%), followed by valproic acid (23%), mirtazapine and venlafaxine (16% each), quetiapine (15%), lamotrigine (14%) and olanzapine (13%). Both, lithium and valproic acid are often combined with selective serotonin reuptake inhibitors (SSRI), but also with mirtazapine und venlafaxine. Combinations of more than one antidepressant occur quite often, whereby combinations with bupropion, paroxetine, fluoxetine or fluvoxamine are very rare. In 2010, quetiapine (alone and combined) was the most frequently prescribed drug (39%); aripiprazole was administered in 10%.

Conclusion

Combinations of antidepressants (SSRI, mirtazapine, venlafaxine) with mood stabilizers (lithium, valproic acid, lamotrigine) and / or atypical antipsychotics (quetiapine, olanzapine) are common. Of most of those combinations the efficacy has not been studied. The use of aripiprazole and the concomitant use of two or three antidepressants contrast the guidelines.

Keywords:
AMSP; Bipolar depression; Bipolar disorder; Combination therapy; Drug surveillance; Guidelines; Pharmacotherapy; Prescription; Psychotropic drugs; Antidepressants