Psychotropic Prescribing Patterns Among Bipolar‐I Patients Prior to Established Bipolar‐I Disorder Diagnosis
Filmon Haile, Clayton English, Kyueun LeeABSTRACT
Objective
Bipolar I Disorder (BP‐I) is frequently misdiagnosed as Major Depressive Disorder (MDD), delaying appropriate treatment. This study aimed to examine treatment patterns among BP‐I patients misdiagnosed with MDD and assess the impact of these regimens on the time until BP‐I diagnosis.
Methods
A retrospective cohort study was conducted using the MarketScan Commercial Claims and Encounters database, analyzing 21,771 BP‐I patients initially misdiagnosed with MDD and 50,667 correctly diagnosed BP‐I patients. Treatment patterns and their influence on time to BP‐I diagnosis were assessed using multinomial logistic regression and Cox proportional hazards models.
Results
Among the misdiagnosed cohort, 25.1% were initially started on antidepressant monotherapy, with 8.7% continuing this regimen after BP‐I diagnosis. In contrast, 7.6% of the initially BP‐I diagnosed cohort received antidepressant monotherapy. The time to BP‐I conversion was shortest for those on mood stabilizer monotherapy (HR: 1.26, 95% CI: 1.19–1.34, p < 0.001), compared to those on antidepressant monotherapy. After BP‐I diagnosis, patients originally misdiagnosed with MDD had different prescribing patterns, exhibiting lower rates of guideline‐consistent treatments. Specifically, patients initially diagnosed with BP‐I were more likely to receive mood stabilizing therapy, either as monotherapy (OR = 2.63, p < 0.001) or in combination with an antidepressant (OR = 1.84, p < 0.001).
Conclusion
Misdiagnosis of BP‐I as MDD leads to significant delays in accurate diagnosis and inappropriate treatment regimens, highlighting the critical need for improved diagnostic accuracy at initial presentation. Prompt and accurate BP‐I diagnosis can optimize treatment approaches and improve patient outcomes.