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Drug treatment patterns in bipolar disorder: analysis of long-term self-reported data

Michael Bauer1*, Tasha Glenn2, Martin Alda3, Kemal Sagduyu4, Wendy Marsh5, Paul Grof67, Rodrigo Munoz8, Emanuel Severus1, Philipp Ritter1 and Peter C Whybrow9

Author Affiliations

1 Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, Dresden 01307, Germany

2 ChronoRecord Association Inc., Fullerton, CA 92834, USA

3 Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada

4 Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO 64110, USA

5 Department of Psychiatry, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, USA

6 Department of Psychiatry, University of Toronto, Toronto, Ontario M5S 1A1, Canada

7 Mood Disorders Centre of Ottawa, Ottawa, Ontario K1G 4G3, Canada

8 Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA

9 Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA), 300 UCLA Medical Plaza, Los Angeles, CA 90095, USA

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International Journal of Bipolar Disorders 2013, 1:5  doi:10.1186/2194-7511-1-5

Published: 3 May 2013



The objective of this study is to investigate drug treatment patterns in bipolar disorder using daily data from patients who received treatment as usual.


Patients self-reported the drugs taken daily for about 6 months. Daily drug use and drug combinations were determined for each patient, both by the specific drugs and by medication class. The drug load was calculated for all drugs taken within a medication class.

Results and discussion

Four hundred fifty patients returned a total of 99,895 days of data (mean 222.0 days). The most frequently taken drugs were mood stabilizers. Of the 450 patients, 353 (78.4%) took a stable drug combination for ≥50% of days. The majority of patients were taking polypharmacy, including 75% of those with a stable combination. Only a small number of drugs were commonly taken within each medication class, but there were a large number of unique drug combinations: 52 by medication class and 231 by specific drugs. Eighty percent of patients with a stable combination were taking three or less drugs daily. Patients without a stable combination took drugs but made frequent changes. Taking more than one drug within a medication class greatly increased the drug load.

To summarize, (1) patients were more likely to take a mood stabilizer than any other drug; (2) although most patients were taking polypharmacy, there were no predominant drug regimens even among those taking a stable combination; and (3) most patients with a stable combination take a relatively small number of drugs daily. The wide variation in drug regimens and numerous possible drug combinations suggest that more evidence is needed to optimize treatment of bipolar disorder.

Bipolar disorder; Drug treatment patterns; Drug load; Polypharmacy