Many bipolar patients missing out on most effective treatments, study finds

Almost a quarter of patients with bipolar disorder in Scotland are being prescribed medication that could make symptoms worse, according to new research.

The University of Glasgow-led study found that most patients with the disorder are missing out on “optimal treatments” and that many are receiving treatments that are “at best ineffective and, at worse, detrimental for long-term outcome”.

The research found that many patients with bipolar disorder in Scotland are on combinations of medication treatments that are out of line with recommended clinical guidelines.

Only around one in 20 patients (5.9%) were prescribed lithium on its own, which researchers said is the recommended first-line treatment for bipolar disorder because of its proven effectiveness in preventing episodes of depression and mania.

However almost a quarter (24.96%) of patients were found to be taking antidepressants as their only medication treatment, despite the risk that such medication can cause mood destabilisation and may precipitate episodes of mania in people with bipolar disorder.

The study found that patients with bipolar disorder were also prescribed other medications such as antipsychotic and anticonvulsant drugs, neither of which are proven to be as effective as lithium in managing the disorder long-term.

Daniel Smith, Professor of Psychiatry at the University of Glasgow, who led the study, said: “These findings are a matter for concern. They suggest that many people in Scotland with bipolar disorder may not be getting the best medication treatment.

“Specifically, we found that there was a gradual decline in the prescribing of lithium (the best for bipolar disorder) and a pattern of consistently high prescribing of antidepressants on their own.

“For many patients, the use of antidepressants in bipolar disorder runs the risk of making the long-term course of the illness worse, rather than better.

“It’s not clear why psychiatrists are prescribing less lithium – it may be because of changes in clinical training or because of effective marketing of medications like antipsychotics.

“We hope these findings will act as a stimulus for greater use of lithium in bipolar disorder and less use of antidepressants on their own, in line with current clinical guidelines.”

The researchers studied data from electronic hospital records and prescribing records in a cohort of 23,135 patients with bipolar disorder from across Scotland, between the years 2009 and 2016.

Within the period studied, researchers found that lithium prescriptions fell, while antidepressant treatment remained stable and antipsychotic and anticonvulsant drug prescriptions increased.

Recent research suggests that lithium therapy has fewer harmful side-effects than previously thought and is in fact the only psychiatric medication proven to be anti-suicidal, the university said.

Dr John Crichton, chairman of the Royal College of Psychiatrists in Scotland, said: “Lithium is an effective medicine, particularly in the maintenance treatment of bipolar disorder.

“We welcome this important and timely research from the University of Glasgow which shows that more can be done to ensure lithium is provided as a core treatment option for people with bipolar disorder, in line with clinical guidelines.”

The research is published on Thursday in the British Journal of Psychiatry.

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