Preventing bipolar relapse: Which factors are associated with different mood stabilizer therapy?

Abstract

Background:

As bipolar disorder drastically afflicts the patient's family, social, and occupational life alongside with a high suicide rate, early initiation and maintenance of pharmacotherapy is crucial. However, bipolar relapse prevention including modern atypical antipsychotics still deserves research.

Methods:

Targeting relapse prevention in a natural setting, this ongoing 18-months, prospective, multicenter, non-interventional study compares mood-stabilizing therapies in German outpatients with bipolar disorder.

Results:

The present analysis of baseline-data reveals that of 761 adults included, 26.1% are receiving olanzapine monotherapy (OM), 21.2% lithium monotherapy (LM), 30.1% anticonvulsant monotherapy (AM), 6.4% olanzapine/lithium combination therapy (OLC), 9.5% olanzapine/anticonvulsant combination therapy (OAC), 6.7% other combinations of mood stabilizers (OC) and 5.8% no mood stabilizers (NO). A higher rate of females receive AM (32.5%, males 22.9%) while males are rather treated with OM (26.6%, females 23.0%). At baseline, 36.4% of the patients had been hospitalized within the last 12 months due to psychiatric disorder, 26.8% had a history of suicide attempts, 10.7% were considered rapid cyclers.

Within the last 12 months 66.5% of the patients experienced manic episodes, 88.6% depressive episodes and 43.1% mixed episodes. The highest rates of prevalent diabetes mellitus (12.6%) and lipid disorders (17.5%) and second highest of cardiovascular disease (20.4%) was found in Patients receiving LM. Employment rate at baseline was highest in the AM-group (39.6%) and lowest with OC (29.2%).

Conclusion:

The present data show that these patients in whom maintenance therapy was initiated, form an exceedingly heterogeneous population, suggesting a strong demand for individually customized therapies.