Clinical prescription of lithium, anticonvulsants antipsychotics, and antidepressants for major mood disorders.

Background: As choices of treatments for bipolar disorder types I (BD1) and II (BD2) and major depressive disorder (MDD) continue to evolve, we reviewed studies directly comparing current clinical usage rates of medicinal treatments for these disorders.

Methods: Comprehensive searching of five literature databases through March 2024 identified reports on clinical drug prescription rates for BD and MDD patients. Rates were summarized and compared by random-effects meta-analyses with R-Studio software.

Results: A total of 18 reports (2006-2023) supported comparisons of clinically prescribed treatments for 17,572 mood-disorder patients (mean age 42.8 years; 7936 BD1 age 43.2 years; 6309 BD2, age 43.3; 3327 MDD, age 40.0). Among diagnoses: (BD1 vs. BD2 vs. MDD), treatments differed as: lithium (54.4% vs. 38.0% vs. 6.78%), second-generation antipsychotics (41.6% vs. 22.3% vs. 15.9%), valproate (25.7% vs. 21.5%; no MDD data), lamotrigine (13.1% vs. 27.2%; no MDD data), and antidepressants (34.9% vs. 46.4% vs. 77.5%). International use of lithium for BD appeared to increase between 2006 and 2023.

Limitations: Outcomes were heterogeneous and requiring inclusion of lithium may introduce selection bias.

Conclusions: Clinical treatment selections for BD1, BD2, and MDD patients differed substantially. Use of modern antipsychotics is undergoing major increases for both BD and MDD; optimal use of antidepressants for BD remains uncertain; and notably, international use of lithium tended to increase in the present data.