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Trends in Use of Antipsychotics and Mood Stabilizers Among Medicaid Beneficiaries With Bipolar Disorder, 2001–2004

Dr. Depp is with the Sam and Rose Stein Institute for Research on Aging and Dr. Gilmer and Dr. Ojeda are affiliated with the Department of Family and Preventive Medicine, University of California, San Diego. Dr. Mastin is a consulting pharmacist to the California Department of Veterans Affairs, Sacramento. Dr. Unützer is with the Department of Psychiatry, University of Washington, Seattle. Send correspondence to Dr. Gilmer at the the Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Dr. 0622, La Jolla, CA 92093-0622 (e-mail: tgilmer{at}ucsd.edu).

OBJECTIVE: This study examined longitudinal trends in the use of mood stabilizers and antipsychotics for treatment of bipolar disorder in a large public mental health system and whether trends differed by age, gender, and race-ethnicity. METHODS: Data were from Medicaid beneficiaries with bipolar disorder receiving services in the San Diego County public mental health system from 2001 to 2004. For each year the proportion of clients receiving any pharmacotherapy and the proportion receiving antipsychotics alone, mood stabilizers alone, or antipsychotics plus mood stabilizers were determined. Pharmacotherapy use was examined by age, gender, and race-ethnicity. RESULTS: A total of 1,473 clients were identified who were continuously enrolled in Medicaid during the four years. Seventy-five percent received mood stabilizers or antipsychotics. Of this group, 33% received antipsychotics alone, 23% mood stabilizers alone, and 44% both antipsychotics and mood stabilizers. The percentage receiving mood stabilizers or antipsychotics increased significantly, from 71% in 2001 to 77% in 2004, primarily because of increased use among women. Use of mood stabilizers alone declined from 25% to 20%, and use of antipsychotics alone increased from 32% to 36%. African Americans and Latinos were less likely than non-Latino whites to receive mood stabilizers or antipsychotics; this pattern was stable over time. CONCLUSIONS: Antipsychotics were prescribed for a larger percentage of clients than mood stabilizers. Persons from ethnic minority groups were less likely to receive either medication type. Research is needed to examine factors affecting pharmacotherapy in bipolar disorder and mechanisms underlying racial-ethnic disparities in pharmacotherapy, including their persistence over time.

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