According to the results of a recent survey conducted by Decision Resources (“one of the world’s leading research and advisory firms focusing on pharmaceutical and healthcare issues”), 52.3 percent of newly diagnosed bipolar disorder patients are prescribed antidepressant drugs first line. (See the press release “Astonishing 52 Percent of Newly Diagnosed Bipolar Disorder Patients Receive Antidepressant Drugs in First-Line Treatment.”)
The new report entitled “Treatment Algorithms in Bipolar Disorder,” points out that although most people with bipolar disorder are diagnosed by a psychiatrist, increasing percentages are being diagnosed and treated by their primary care physician. (You can read the abstract by clicking here.) The numbers break down like this:
- 51% of surveyed primary care physicians specify selective serotonin reuptake inhibitors (including Lexapro, Paxil, and Prozac) as a favored first-line treatment for patients with bipolar disorder I with acute depression.
- 52% of surveyed physicians specify selective serotonin reuptake inhibitors as a favored first-line treatment for patients with bipolar disorder II with acute depression without hypomania.
- 46% of surveyed physicians specify selective serotonin reuptake inhibitors as a favored first-line treatment for patients with acute depression with hypomania.
Although primary care physicians seem to be more comfortable in diagnosing bipolar disorder, Madhuri Borde, Ph.D., analyst at Decision Resources, points out that primary care physicians follow a very different treatment pattern as compared to the approach psychiatrists usually follow:
“Nearly half of the patients taking selective serotonin reuptake inhibitors first line receive these drugs as a monotherapy, despite guideline recommendations to give bipolar patients presenting with depression an antimanic first line.”
If the results of this study are an accurate indication of what’s really happening in doctors’ offices, this could be a disturbing trend, given that antidepressants (particularly SSRI’s) can possibly unmask bipolar disorder, especially in patients diagnosed as having Bipolar I. (The term “unmask” means that a person who has bipolar disorder and has not reported problems with mania may experience mania when treated for depression.) Prescribing an antidepressant (especially without the protection of an anti-manic agent, such as Lithium) could change the course of the illness, “triggering” a manic episode.
Important: As Dr. Fink points out in her comment following this post, we may need to approach the results of this survey cautiously.
The recommended guideline for treating people with bipolar depression is to use an antimanic medication first-line, preferably a medication that has strong antidepressant properties, such as Lithium or Lamictal. An antidepressant can then be added in later, if needed, and more safely, because the antimanic agent can help prevent a potential switch from depression to mania.
If you’ve been diagnosed as having bipolar disorder, we would like to know whether your primary care physician or a psychiatrist arrived at the diagnosis. What was the first-line treatment he or she recommended? What was the result? If you’re a doctor who has diagnosed and treated bipolar disorder, we would also like you to share your experiences and insights.