The Quality of Ambulatory Treatment for Bipolar Disorder: Is It Slipping?

Among medications for bipolar disorder, the strongest evidence favors lithium for treating acute mania, preventing recurrence, and reducing suicide; valproic acid and carbamazepine are other mood stabilizers of proven efficacy. Over recent decades, the FDA has approved several atypical antipsychotics and lamotrigine for acute manic, mixed, or depressive phases. Using data from 1997–2016 national surveys, investigators examined prescribing patterns of office-based psychiatrists for ambulatory patients who were noted as having any bipolar disorder as a primary diagnosis (up to 3 diagnoses listed per visit).

Analyses were based on a sample of 4419 visits (representing 4.2 million annual visits for bipolar disorder). From 1997–2000 to 2013–2016,…