OBJECTIVES: As a diversity of clinical manifestations complicates the management of bipolar disorder, patients with bipolar disorder represent various treatment patterns. We explored the treatment patterns of bipolar disorder in a real-world clinical setting using the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM).

METHODS: A retrospective cohort study was conducted using the CDM data of approximately 2 million patients who visited Kyung Hee University Medical Center during 2008–2021. We identified patients diagnosed with bipolar disorder with continuous observation of 1 year after the index date, defined as the earliest date of diagnosis. Patients with previous diagnosis or treatment for bipolar disorder were excluded from the study. Patients were followed up until the end of continuous observation in the CDM data. Based on the Korean guidelines on the management of bipolar disorders, treatments included atypical antipsychotic (AAP), mood stabilizer (MS), lamotrigine, and antidepressant (AD). Treatments overlapping ≥7 days were considered as combination therapy. Treatment sequences were explored up to third-line treatments using sunburst plot.

RESULTS: We identified 940 patients newly diagnosed with bipolar disorder (mean age 53.1 years, 56.5% of female patients). The most frequent first-line treatment was AAP monotherapy (38.9%), followed by AAP combined with MS (24.5%), MS combined with AD (10.2%), and MS monotherapy (9.9%). Quetiapine and valproate were the most frequently used drug among AAPs and MSs. Approximately 45% of patients switched to the second-line treatments, and most of them received augmentation therapy. Manic patients tended to use AAP combined with MS (52.9%) and AAP monotherapy (20.2%), while depressive patients tended to use AD monotherapy (32.1%) and AAP combined with MS (23.8%).

CONCLUSIONS: The common treatments for bipolar disorder were found to be AAP monotherapy or combined with MS. In subsequent treatments, most patients received augmentation therapy rather than switched to the other drug classes.