Prescription Patterns of Psychotropic Medications in Elderly Compared With Younger Participants Who Achieved a “Recovered” Status in the Systematic Treatment Enhancement Program for Bipolar Disorder
Open accessAbstract
Objectives This study compares prescription patterns between young adults and elderly with bipolar disorder who achieved a recovery status during the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).Design STEP-BD is a multicenter National Institute of Mental Health-funded project designed to evaluate the longitudinal outcome of patients with bipolar disorder. The STEP-BD study involved extensive assessment across multiple domains including demographic data, diagnosis, symptom severity, treatment, and clinical status. Patients achieved "recovered" status when they experienced eight consecutive weeks without significant symptoms.Participants The authors analyzed data of all subjects who achieved a recovered status at least once in their participation.Measurements The authors compared treatment regimes and doses among young participants with middle age (N = 3,364), 20-59 years old, and older participants 60 and above (N = 246).Results Of the 3,615 STEP-BD participants who had a lifetime diagnosis of bipolar subtypes I or II, 67.6% (N = 2442) achieved a recovered status during their participation. A total of 78.5% (N = 193) of older patients recovered compared with 66.8% of the younger cohort. On average, participants who reached a recovered status took 2.05 medications with no difference between age groups. Lithium was prescribed to 37.8% of younger patients compared with only 29.5% of older participants. The mean dosages taken by younger and older patients differed significantly only for lithium, valproate, and risperidone with elderly individuals prescribed lower daily dosages. Significant reduction in lithium dosing was observed among individuals aged 50 and older and among individuals 60 and older for valproate. Although valproate was more often prescribed, 42.1% of recovered bipolar elder achieved recovery with lithium alone compared with only 21.3% of the younger cohort.Conclusion This data shows recovery is achievable in the elderly though more than one medication is often needed regardless of age.
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A post hoc analysis of the STEP-BD study found that, on average, older patients required a similar number of medications to younger patients to achieve recovery, but lower doses were used.
“A post hoc analysis of the STEP‐BD study found that while, on average, older patients required a similar number of medications to younger patients to achieve recovery, lower doses were used.”
From Canadian Network for Mood and Anxiety Treatments ( <scp>CANMAT</scp> ) and International Society for Bipolar Disorders ( <scp>ISBD</scp> ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [653]
The Results (Demographics; page not available) report nearly identical mean medication counts at recovery: 2.06 for patients 60 and older versus 2.05 for younger patients. The Results (Dosing of Commonly Prescribed Psychotropic Medications by Age; page not available) report significantly lower mean doses in older patients for lithium, valproate, and risperidone only—not lower doses across medications generally. The study measured medications at recovery rather than establishing how many were required to achieve it. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn the STEP-BD sample, over twice as many older patients as younger ones recovered using lithium alone (42% vs 21%).
“In that sample, over twice as many older patients as younger ones recovered using lithium alone (42% vs 21%, respectively).653”
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Clinical Management of Older Age Bipolar Disorder
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Primary Care Physicians’ Attitudes Regarding Collaborating With Home-Based Depression Care Managers
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“Many clients need antidepressants to experience relief,(7) or receive antidepressants and remain symptomatic,(8) requiring ongoing antidepressant monitoring and adjustments to achieve symptom reduction.(9) These clients also have high rates of comorbid 480178 HHCXXX10.”
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Treatment of Bipolar Disorder in Special Populations
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Medicines for bipolar disorder in older people
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Treatment of Bipolar Disorder in Old Age
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Current Pharmacotherapies in Older Age Bipolar Disorder
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Considerations about the Treatment of Mood Disorders in Elderly Patients
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Trouble bipolaire chez la personne âgée
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Prescribing patterns in older adults with bipolar affective disorder: a service evaluation
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Characteristics and Treatment of Bipolar Disorder in the Elderly
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- Authors
- Al Jurdi, R. K., Marangell, L. B., Petersen, N. J., Martinez, M., Gyulai, L., & Sajatovic, M.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- University of Pennsylvania (US)
- University Hospitals Cleveland Medical Center (US)
- ORCID
- Sajatovic, Martha
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2008-11
- Volume
- 16
- Issue
- 11
- Pages
- 922-933
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC2630050
- OpenAlex
- W1975129134
- Cited by
- 72
- References
- 38
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 1 · 2021: 4 · 2020: 4 · 2019: 4 · 2018: 5 · 2017: 9 · 2016: 3 · 2015: 5 · 2014: 5 · 2013: 5 · 2012: 4
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01mh80001-12-0-0)
- National Institute of Mental Health (N01 MH080001)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- bipolar disorder, older adults, psychotropic drugs, prescribing patterns, recovery, lithium, valproic acid, risperidone, drug dosing, age differences
- MeSH terms
- Adult, Aged, Aged, 80 and over, Analysis of Variance, Antidepressive Agents, Bipolar Disorder, Drug Utilization, Female, Humans, Male, Middle Aged, Practice Patterns, Physicians', Psychiatric Status Rating Scales, Psychotropic Drugs, United States, Valproic Acid, Treatment Outcome, Lithium Compounds, Antimanic Agents, Prescriptions
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