Patterns and trends of medication use among patients with bipolar disorder in Northeast China: A study from a large psychiatric center (2013-2022).

Background: The medication patterns and trends among bipolar disorder patients in mainland China remain unclear. This study, as the first attempt in northeast China, is designed to clarify the medication patterns and elucidate medication trends of bipolar disorder patients from 2013 to 2022.

Methods: The study included 1812 bipolar disorder patients from a large psychiatric center who received treatment from 2013 to 2022. We examined the episode types of patients and medications for treatment of bipolar disorder, including lithium, anticonvulsants, antipsychotics, antidepressants, and sedative-hypnotics. Trends of episode types, medication, and combinations were analyzed using the Cochran-Armitage Trend test. Patterns of medication use were analyzed using the association rule mining method.

Results: Among the patients, manic/hypomanic episode accounted for 63.11 % to 75.39 % from 2013 to 2022. Antipsychotics had the highest usage rate (2022: 97.84 %) and showed a significant increasing trend. Lithium had the lowest usage rate (2022: 7.91 %), with no significant trend. Furthermore, combination therapy, particularly three medications, was the major treatment regimen. The proportion of patients receiving combination therapy involving three types of medications ranged from 46.07 % to 64.03 %. The most common pattern for manic/hypomanic patients was sedative-hypnotics + anticonvulsants + antipsychotics, whereas the preferred medication pattern for depressive patients was antipsychotics + antidepressants + sedative-hypnotics.

Conclusions: In China, manic/hypomanic episodes remained the predominant episode type. Combination therapy, particularly with three medications, was most commonly used for treatment of bipolar disorder patients and the patterns were episode-specific. Lithium remained the least commonly prescribed medication for both episode types.