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Clinical use of mood stabilizers beyond treatment for bipolar disorder: The REAP-MS study

Chen CK 1 , Yang SY 2 , Park SC 3 , Jang OJ 4 , Zhu X 5 , Xiang YT 6 Show all authors , Ouyang WC 7 , Javed A 8 , Khan MNS 9 , Grover S 10 , Avasthi A 10 , Kallivayalil RA 11 , Chee KY 12 , Chemi N 13 , Kato TA 14 , Hayakawa K 14 , Pariwatcharakul P 15 , Maramis M 16 , Seneviratne L 17 , Sim K 18 , Tang WK 19 , Oo T 20 , Sartorius N 21 , Tan CH 22 , Chong MY 23 , Park YC 24 , Shinfuku N 25 , Lin SK 26

Affiliations 

  • 1 Department of Psychiatry, Keelung Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taiwan
  • 2 Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
  • 3 Department of Psychiatry, Hanyang University College of Medicine, Seoul, the Republic of Korea; Department of Psychiatry, Hanyang University Guri Hospital, Guri, the Republic of Korea
  • 4 Department of Psychiatry, Bugok National Hospital, Changyeong, the Republic of Korea
  • 5 Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University, Suzhou, China
  • 6 Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences & Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
  • 7 Department of Geriatric Psychiatry, Jianan Psychiatric Center, Tainan, Taiwan; Department of Psychiatry, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
  • 8 Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
  • 9 Department of Psychiatry, Services Hospital, Lahore, Pakistan
  • 10 Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 11 Pushpagiri Institute of Medical Sciences, Tiruvalla, India
  • 12 Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
  • 13 Department of Psychiatry and Mental Health, Hospital Kajang, Selangor, Malaysia
  • 14 Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • 15 Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 16 Department of Psychiatry, Dr. Soetomo Hospital - Faculty of Medicine, Airlangga University, Surabaya, Indonesia
  • 17 Department of Psychiatry, University of Sri Jayewardenepura, Sri Lanka
  • 18 Institute of Mental Health, Buangkok Green Medical Park, Singapore
  • 19 Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
  • 20 Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar
  • 21 Association for the Improvement of Mental Health Programs, Geneva, Switzerland
  • 22 Department of Pharmacology, National University of Singapore, Singapore
  • 23 Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia
  • 24 Department of Psychiatry, Hanyang University College of Medicine, Seoul, the Republic of Korea
  • 25 School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
  • 26 Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Psychiatry, Taipei City Hospital and Psychiatric Center, Taipei, Taiwan. Electronic address: sklin@tpech.gov.tw
Asian J Psychiatr, 2023 Jul;85:103613.
PMID: 37163943 DOI: 10.1016/j.ajp.2023.103613

Abstract

OBJECTIVE: Mood stabilizers are psychotropic drugs mainly used to treat bipolar disorder in the acute phase or for maintenance therapy to prevent relapse. In clinical practice, mood stabilizers are commonly prescribed for conditions other than bipolar disorder. This study investigated the distribution of mood stabilizer prescriptions for different psychiatric diagnoses and studied differences in the drugs, dosage, and plasma concentration in 10 Asian countries including Taiwan, South Korea, Malaysia, China, Thailand, India, Pakistan, Singapore, Indonesia, and Myanmar.

METHODS: Patients prescribed mood stabilizers (lithium, carbamazepine, valproic acid, or lamotrigine) for a psychiatric condition other than bipolar disorder (codes F31.0-F31.9 in the International Classification of Diseases, 10th Edition, Clinical Modification) were recruited through convenience sampling. A website-based data entry system was used for data collection.

RESULTS: In total, 1557 psychiatric patients were enrolled. Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29, 55.8 %) was the most common diagnosis, followed by non-bipolar mood disorders (F30, F31- F39, 25.3 %), organic mental disorder (F00-F09, 8.8 %), mental retardation (F70-F79, 5.8 %) and anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (F40-F48, 4.4 %). The most frequently targeted symptoms (>20 %) were irritability (48 %), impulsivity (32.4 %), aggression (29.2 %), anger (20.8 %), and psychosis (24.1 %). Valproic acid was the most frequently used medication.

CONCLUSIONS: Clinicians typically prescribe mood stabilizers as empirically supported treatment to manage mood symptoms in patients with diagnoses other than bipolar disorders, though there is on official indication for these disorders. The costs and benefits of this add-on symptomatic treatment warrant further investigation.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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