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Mental health conditions

One in four bipolar patients not receiving effective treatment, study finds

As many as 25% of patients with bipolar disorder are being prescribed antidepressants without lithium, a study has found, which could worsen symptoms and stimulate episodes of mania.

The web page on bipolar disorder


A study has found that as many as one in four patients with bipolar disorder are not being prescribed the right combination of medicines, which could stimulate or worsen episodes of mania

Patients with bipolar disorder are not being prescribed effective treatment and some patients are receiving drugs that could make their symptoms worse, a study published in the British Journal of Psychiatry has suggested.

Researchers from the University of Glasgow and the NHS Greater Glasgow and Clyde looked at medicines given to people with bipolar disorder from 2009 to 2016 to investigate any changes in prescribing patterns.

They found that 25% of the 23,135 patients studied were given antidepressants but were not being prescribed lithium. The use of antidepressants alone without a mood stabiliser such as lithium may worsen or stimulate episodes of mania in people with bipolar disorder, the researchers said.

While the study was based on Scottish data, the researchers reported that “these trends [in prescribing] are likely to reflect practice across the UK”.

Researchers said “the findings are concerning and represent a gap between treatment guidelines and clinical practice”.

David Taylor, director of pharmacy and pathology at South London and Maudsley NHS Foundation Trust, said the findings were “likely to apply broadly to bipolar patients in England and Wales”.

He said lithium was probably “the best treatment for bipolar but it is somewhat difficult to use and monitor, and is associated with long-term effects on renal function”.

The decline in its use was “perhaps a product of the absence of any marketing by a pharmaceutical manufacturer and clinicians’ fears over worsening the condition if lithium is stopped suddenly”, added Taylor.


Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206247

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