Abstract

Objectives

To assess the effect of second-generation antidepressants on mania-related and depression-related office visits for adults with bipolar disorder.

Methods

Using a national managed-care claims database, we retrospectively identified continuously enrolled patients with bipolar disorder who had a new antidepressive prescription treatment between January 1998 and December 2002. Patients were followed for at least 12 months after the date of initial use of antidepressant monotherapy, mood stabilizer monotherapy, or antidepressant–mood stabilizer combination therapy. Logit models with propensity score matching were used to identify the relationship between treatment types and the likelihood of having mania-related visits within 12 months. Negative binomial models and Cox proportional hazard models were used to predict the number of depression-related visits and time to first mania- or depression-related visit.

Results

Patients on antidepressant monotherapy and combination therapy did not have different likelihoods of mania-related visits compared with those on mood stabilizer monotherapy (with odds ratios (ORs) 0.67 (95% confidence interval (CI) 0.42–1.04) and 0.99 (95% CI 0.69–1.43), respectively). The numbers of depression-related visits for the same comparisons were significantly lower, with incidence rate ratios of 0.68 (95% CI 0.56–0.82) and 0.65 (95% CI 0.52–0.81), respectively. The results of time to first mania- or depression-related visit provided similar indications.

Conclusion

Second-generation antidepressant was associated with a decreased number of depression-related visits but was not associated with an increased risk of mania-related visits within a 1-year period. Although more work is needed to establish the safety and efficacy of second-generation antidepressants in treating bipolar depression, the evidence from this study supports a favorable risk–benefit profile.