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Am J Psychiatry 1996; 153:711-713
Copyright © 1996 by American Psychiatric Association
Trends in pharmacotherapy of Schizoaffective and bipolar affective disorders: a 5-year naturalistic study
HH Fenn, D Robinson, V Luby, C Dangel, E Buxton, M Beattie, H Kraemer and JA Yesavage
Psychiatry Service 116A/5C4, Veterans Affairs Health Care System, Palo Alto, CA 94304, USA.
OBJECTIVE: The authors' goal was to determine if the actual treatment of
schizoaffective and bipolar affective disorders had changed in light of
recent clinical drug trials that have suggested that valproate and
carbamazepine may be equivalent in efficacy to lithium. METHOD: Medication
utilization rates for each 6-month period from July 1, 1989, to June 30,
1994, were compiled from the clinical database of the Palo Alto Veterans
Affairs Medical Center. Results: The use of valproate and valproate plus
lithium was negligible in 1989. by 1994, these medication regimens
accounted for 25% of the standard antimanic treatments used for bipolar
affective disorder and 38% of the treatments used for schizoaffective
disorder. Regimens of carbamazepine and carbamazepine plus lithium dropped
from 24% of antimanic treatments in 1989 to 18% in 1994. From 1989 to 1994,
there was a decline in the rate of lithium monotherapy for treatment of
bipolar affective disorder (from 84% to 43%) and schizoaffective disorder
(from 100% to 53%). CONCLUSIONS: In the past 5 years, valproate monotherapy
has increased as a percentage of total antimanic pharmacotherapies, while
lithium monotherapy has declined.
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