Bipolar Therapy Choices and Trends

A new report, Treatment Algorithms in Bipolar Disorder, has found that over 52 percent of patients that are newly diagnosed with bipolar disorder are being prescribed antidepressants. They also found that the high numbers of prescribed anti-depressants that are coming from the first line of treatment are from primary care physicians. The report was created by Decision Resources, a leading research and advisory firm on healthcare and pharmaceutical issues. The report gives insight into therapy choices and prescribing trends.

The primary care physicians that were surveyed said they were in favor of Lexapro and other selective serotonin reuptake inhibitors for bipolar disorder, with these statistics:

Bipolar disorder I with acute depression – 51 percent

Bipolar disorder II with acute depression, without hypomania – 52 percent

Bipolar disorder II with acute depression and hypomania – 46 percent

The report also stated that many primary care physicians were diagnosing quite differently than psychiatrists. Most primary care physicians are treating bipolar disorder with a monotherapy, although guidelines state that bipolar patients with depression should receive an antimanic first line.

The report also found that Lamictal from GlaxoSmithKline is the leading single-agent in therapy, whether it was first, second or third-line treatment. Eighteen percent of psychiatrists prefer Lamictal for first-line treatment, 13.8 percent prefer it for second- line treatment and 16.3 percent prefer it for third-line treatment. In particular, psychiatrists seem to prefer Lamictal for:

Bipolar disorder I with acute depression: 59 percent

Bipolar disorder II with acute depression, without hypomania: 61 percent

And many psychiatrists prefer Lamictal and Abbott’s Depakote ER as a combination therapy:

Bipolar disorder II with acute depression: 45 percent

Bipolar disorder II with hypomania: 32 percent

The report examined information such as drug usage by line of therapy, summary of U.S. medical practice, qualitative diagnosis, discussion of key freeform combinations by lines of therapy, product share within each line of therapy, progression of therapy from key first-line products, pathway to key therapies and qualitative analysis of two-year forecast.


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