20-year pharmacological treatment trajectories in a cohort of patients with bipolar disorder

BACKGROUND: Bipolar disorder (BD) is a prevalent, chronic and severe condition, with a high impact on psychosocial functioning. In the treatment of BD, maintenance therapy is crucial for preventing affective recurrences and long-term complications. The goal of this study was to conduct a descriptive analysis of the trajectories of pharmacological treatment along 20 years in a cohort of patients with BD, to better understand the diversity and changes in treatment patterns. METHODS: This study analyses the prescription patterns of psychotropic medications and their association with clinical variables (sex, BD type, predominant polarity and psychotic symptoms) in a sample of 68 outpatients with BD (54.4% female, age of 39.31±12.04 at the start of the study) over a 20-year period. RESULTS: Maintenance therapy was predominantly based on combination strategies (75.8% at baseline). Our findings showed an increase in polypharmacy and benzodiazepines and a decline of mood stabilizers. CONCLUSIONS: This study offers insight into maintenance medication patterns among BD patients in a real-world setting over an extended period, revealing how prescribing tendencies have evolved. The widespread use of polypharmacy and benzodiazepines and the decrease in the prescription of mood stabilizers during the follow-up highlight a noticeable divergence between clinical practice and guideline recommendations.