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.
I have to say I am a little skeptical of this data and the conclusions that might be drawn from it. Here are some of the reasons I question this survey and whether it accurately reflects what’s actually happening in the doctor’s office:
I just can’t tell you how many psychologists and social workers call to tell me about a patient we share that they’re “sure” must be bipolar just because the patient has rage outbursts or erratic moods over the course of a day. This is not the same as bipolar but lots of people – and I am sure primary care physicians included (because lots of psychiatrists are even confused about this) – don’t understand the difference. And those people with mood regulation problems, but not bipolar, often do really well on SSRI’s alone.
The information in the study also doesn’t say anything about rates of negative consequences to these prescribing patterns – it just lists these patterns without any real context of what really happens out in the world.
I think it is a worthy discussion – primary care docs are getting more involved in this because of inadequate availability of psychiatrists and poor reimbursement for mental health care – so it is important, but I’m just not sure this study gives us a great deal of useful info.
My name is Lisa Carter and i would like to show you my personal experience with Lexapro.
I am 39 years old. Have been on Lexapro for 2 years now. This medication had an almost immediate positive effect on my life. Within 2 to 3 days of starting Lexapro, there was a noticeable lift in my general mood. A WARNING ABOUT STOPPING OR WEANING OFF LEXAPRO: I started taking 10 mg daily a couple of years ago for about 2 months, then decided I just didn’t want to take medicine every day. So I weaned myself off over a 2-wk period, first reducing the dose to 5 mg/day, then 5 mg every other day before I stopped altogether. I figured I would be able to tell if my mood was going downhill and I would just restart if it did. Well, there was no gradual decline. I was careful to monitor my mood and thoughts every day and everything went great for about 3 months, then C.R.A.S.H!!! I mean it hit me like a WALL, very very suddenly! Despite exercising 4-5x per week, healthy eating, etc., I hit an all-time low.
I have experienced some of these side effects-
Constant dull headache, jittery in the morning if taken before bed, dizziness. These negative side effects subsided within a week or two. Other side effects have continued, including sleepiness and yawning, apathy, vivid (but great) dreams. My libido died and never came back.
I hope this information will be useful to others,
Lisa Carter
My husband is mean when he doesn’t take his medicine.He really scares me just like my x husband did but he beat on me.I don’t have a an automobile and he won’t let me drive anymore.
I am the partner of a man with Bipolar Disorder, or at least that is what we think he has. He visited his doctor approximately 3 months ago after a very stressful time. He was suffering extremely erratic moodswings, and I suggested to him that I didnt think it was a simple case of Depression. We both did hours of research into the different types of mental illness before he approached his doctor. After completing many Bipolar Questionaire tests online, all of which scored extremely high for Bipolar, he went to his doctor to explain that this is what he was sure he had, and had had for many years previous.
His doctor (junior Doctor) said that it wasnt bipolar, but simple depression and pescribed him SSRI’s. The first month, we saw some improvement and when he visited the doctor and told him this, the doctor for some reason thinking the tables were working, decided to double the dosage. Within about 6 weeks of this happening came a drastic change.
My partner became unbareable to live with. I didnt know from one day to the next how he would react to everyday situations, he became extremely jealous, but at the same time very distant from any feelings he just weeks early, had for me and our unborn child which we had planned.
Then one day he decided to leave, just like that, said he still loved me but not enough!! But as I broke down infront of him he stood there completely cold and numb. This was not the man that stood infront of me just weeks before. He told me some very nasty things, didnt care about the baby, or me etc.
I then found out just days after he left that he had got involved just a week earlier with a 19 yr old. We are both in our 30’s. I went to his new house and broke down in front of him when I thought I had lost the baby, he just looked at me cold.
A week later I had a phone call from a friend of his telling me he was in a bad way and I needed to see him. I agreed. He was a nervous wreck. Said he just felt as though he had woken from a coma. He cried like a small child for 3 days solid, was confused and shaking. utter disbeleif at the destruction and pain he had caused all around him.
We have since been seen by a mental health crisis team who beleive that he is in fact bipolar and that being pescribed these antidepressants have caused this destructive change in his personality.
We almost lost it all, and now are looking to make a claim against the doctor who made this diagnosis, as in the first instance my partner expressed to him he was utterly sure it was bipolar, and had taken many online tests. All the lifestyle evidence was there including excessive spending, extreme high and low moods, among many others.