Comparative Analysis Of Drug Treatment Of Bipolar Depression In Different Decades

Objective: The aim of this article was to examine the adherence to published guidelines and changes in prescription habits over time by analyzing the pharmacotherapeutic trends of inpatients with bipolar depression among different decades.Method: Data of 318 patients with bipolar depression in 1996,2006,2016 were retrospectively studied,SPSS 19.0 was used to analyze the data,P<0.05 was considered as significant.Results:(1)The switch rate decreased from 1996 to 2016(33.3%,29.6%,18.4%,P=0.042).Switch times positively correlated with length of hospitalization and number of antidepressants used(r=0.319,r=0.251,P<0.05).The later adding a mood stabilizer(MS),the more possible to experience mood switching(P<0.05).Patients diagnosed with depressive disorder had a later time of adding a MS compared with those diagnosed with bipolar depression.(2)The proportion of patients receiving at least one MS increased significantly(56.7%,80%,86.5%,P=0.013).Among the individual mood stabilizers,valproate,which was used most frequently form 2006,showed a significant increase(P=0.001).Lithium showed a decrease of no significance(P=0.132).(3)Antidepressants were used by most patients in all decades(96.7%,99.2%,92%),but monotherapy rate decreased over years(P=0.000).Tricyclics decreased over years(P<0.05).Paroxetine,once was widely used in 2006,was seldom used in 2016(64%,8%,P=0.000).The use of sertraline increased from 2006 to 2016(12.8%,35%,P=0.000)as fluoxetine decreased(8%,1.8%,P=0.016).In2016,duloxetine(27.6%),bupropine(20.9%),mirtazapine(12.3%)and escitalopram(10.4%)were also commonly used.(4)The use of antipsychotics didn't change significantly over years(88.6%,82.9%,79.3%,P=0.082).Sulpiride was widely used in 1996 and 2006(36.7%,34.4%,P=0.880),but seldom used in 2016(1.2%,P=0.000).Prescriptions of quetiapine increased without reaching significance(19.2%,27%,P=0.123),risperidone showed a significant decrease(25.6%,10.4%,P=0.001).Olanzapine was the most commonly used antipsychotic in 2016.(5)Alprazolam and clonazepam were most widely used benzodiazepine in all decades.Clonazepam transfusion was abandoned in 2016,butdiazepam transfusion rate increased significantly.The number and variety of benzodiazepine didn't show correlation with length of hospitalization and curative effect.Conclusion: The use of mood stabilizers increased over years,valproate has become the most commonly used MS.Antidepressants are widely used in every era,while monotherapy decresed but still exists.Benzodiazepines were not standardized used.