Nearly half of adults newly diagnosed with bipolar disorder (BD) are treated with mood stabilizers and/or antidepressants. Few of them initially received guideline-recommended therapy. The researchers published their findings in Advances in Therapy.

Guideline-recommended initial treatments for bipolar I depression are atypical antipsychotics, mood stabilizers, or adjunctive therapy such as a mood stabilizer and an atypical antipsychotic. For bipolar 1 mania, guideline-recommended initial treatment are mood stabilizers, atypical antipsychotics, or a combination of both. Because BD is typically difficult to manage and often treated inappropriately, the researchers turned to the data to find out how doctors treat patients newly diagnosed with BD.

The researchers used health care claims data from the IBM® MarketScan® Commercial Database, pulling records from March 16, 2015, to September 30, 2018. They included patients aged 18 and over whom had received at least 6 months of continuous treatment. The researchers analyzed the first claim for medication after diagnosis (first line of therapy or LOT1) as well as subsequent LOTs.

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Evaluating prescriptions for 40,345 patients, the researchers found the most common first diagnoses were bipolar II disorder (38.1%), bipolar I depression (29.8%), bipolar I mania (12.8%), and bipolar I mixed features (12.0%). Of the 90.7% of total patients who received some type of medication treatment at first diagnosis, the researchers found 2,067 different regimens.

The most common medication classes for the LOT1 group were mood stabilizers (43.8%; 16.0% for monotherapy, 27.8% in combination), antidepressants (42.3%; 12.9% for monotherapy, 29.4% in combination), atypical antipsychotics (31.7%; 10.3% for monotherapy, 21.4% in combination), and benzodiazepines (20.7%; 6.2% for monotherapy, 14.5% in combination). For subsequent LOTs, antidepressant (LOT2, 51.4%; LOT3, 53.8%) and benzodiazepine (LOT2, 26.9%; LOT3, 27.4%) usage increased.

In the LOT1 group, 12% of patients diagnosed with bipolar 1 depression and 22% of patients diagnosed with bipolar 1 mania received guideline-recommended treatment.

The researchers admit that because data was pulled from health care claims, it only included insured patients, so it may not generalize to the population at large. There is also the possibility of data bias and coding errors.

However, the results illustrate the gap between actual therapy and guideline-recommended therapy, the researchers state. “That clinical guidelines were not well followed in this study identifies an opportunity to improve adherence to recommended treatment regimens and the potential of newer therapies to address this need.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

This research was supported by AbbVie. Please see the original reference for a full list of disclosures.


Jain R, Kong AM, Gillard P, Harrington A. Treatment patterns among patients with bipolar disorder in the United States: a retrospective claims database analysis. Adv Ther. Published online April 6, 2022. doi:10.1007/s12325-022-02112-6